Effect of increased lung volume on sleep disordered breathing in sleep apnoea patients

Raphael C Heinzer ^1*, Michael L Stanchina ², Atul Malhotra ³, Amy S Jordan ³, Sanjay R Patel ³, Yu-Lun Lo ⁴, Andrew Wellman ³, Karen Schory ³, Louise Dover ³ and David P White ³

¹ Service de Pneumoilogie, CHUV, Lausanne, Switzerland
² Rhode Island Hospital, Brown Medical School, Providence, RI, United States
³ Sleep Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
⁴ Department of Thoracic Medicine 2, Chang Gang Memorial Hospital, Taipei, Taiwan

^* To whom correspondence should be addressed. E-mail: rheinzer{at}post.harvard.edu.

Accepted 8 February 2006

Abstract

Background: Previous studies have demonstrated that changes in lung volume influence upper airway size and resistance, particularly in obstructive sleep apnoea (OSA) patients, and that continuous positive airway pressure (CPAP) requirements decrease when the lung volume is increased. We sought to determine the effect of a constant lung volume increase on sleep disordered breathing during non REM sleep.

Methods: Twelve OSA subjects were studied during non REM sleep in a rigid head-out shell equipped with a positive/negative pressure attachment for manipulation of extrathoracic pressure. The increase in lung volume due to CPAP (at therapeutic level) was determined with four magnetometer coils placed on the chest wall and abdomen. CPAP was then stopped and the subjects were studied for 1 hour in three conditions (in random order): 1) with no treatment (Baseline); 2) at the "CPAP lung volume", with the increased lung volume being reproduced by negative extrathoracic pressure alone (Lung Volume 1), and 3) 500 ml above the "CPAP lung volume" (Lung Volume 2).

Results: Respectively for baseline, Lung Volume 1, and Lung Volume 2 the mean AHI (SE) was 62.3 (10.2), 37.2 (5.0), and 31.2 (6.7) events per hour (p=0.009); the 3% oxygen desaturation index was 43.0 (10.1), 16.1 (5.4), and 12.3 (5.3) events per hour (p=0.002) and the mean oxygen saturation was 95.4 (0.3) %, 96.0 (0.2) %, 96.3 (0.3) % (p=0.001).

Conclusion: An increase in lung volume yields a substantial decrease in sleep disordered breathing in OSA patients during NREM sleep.

Keywords: CPAP, lung volume, sleep apnea, upper airway

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