Upper airway function and arousability to ventilatory challenge in slow wave versus stage 2 sleep in obstructive sleep apnoea

Rajeev Ratnavadivel^*, Daniel Stadler, Samantha Windler, Jana Bradley, Denzil Paul, R Douglas McEvoy, Peter G Catcheside

Adelaide Institute for Sleep Health, Australia

Correspondence to: Rajeev Ratnavadivel, Adelaide Institute for Sleep Health, Repatriation general Hospital, Daws Road, Daw Park, Adelaide, 5041, Australia; rajeev.ratnavadivel{at}health.sa.gov.au

Accepted 22 September 2009

Obstructive sleep apnoea (OSA) patients have reduced event rates during slow wave sleep (SWS) compared to stage 2 sleep. To explore this phenomenon, we examined ventilatory and arousal timing responses to partial and complete airflow obstruction during SWS vs. stage 2 sleep.

Methods: 10 patients, mean±SD apnoea-hypopnoea index (AHI) 49.7 ± 16.5 events•hr-1 with reduced OSA frequency during SWS (SWS AHI 18.9 ± 14.0 events•hr-1) slept with an epiglottic pressure catheter and nasal mask/pneumotachograph. Patients underwent rapid CPAP dialdowns to 3 sub-therapeutic levels and brief airway occlusions in random order.

Results: Post dialdown, there were marked reductions in peak flow and minute ventilation, and progressive increases in inspiratory effort (p<0.001), but with limited ventilatory recovery and no differences between sleep stages. CPAP versus peak flow relationships on the third and second to last breath pre-arousal were not different between sleep stages. Arousals occurred later and post dialdown arousal probability was lower during SWS compared to stage 2 sleep, Cox hazard ratio (95% CI) 0.65 (0.48-0.88), p=0.006). During SWS occlusions, time to arousal (Mean±SEM) was prolonged (23.0 ± 2.6 vs 17.1 ± 1.7sec, p=0.02). Inspiratory effort developed more rapidly (-1.0 ± 0.2 vs -0.6 ± 0.1 cmH2O•sec-1, p=0.019) and was more negative (-28.7 ± 2.7 vs -20.3 ± 1.6 cmH20, p<0.001) on the breath preceding arousal.

Conclusions: Except for heightened ventilatory drive response during airway occlusion, airway function and ventilatory compensation to ventilatory challenge appear to be similar, but with consistently and substantially delayed arousal responses, in slow wave versus stage 2 sleep.

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