Accuracy of Respiratory Inductive Plethysmography during Wakefulness and Sleep in Patients with Obstructive Sleep Apnea

doi:10.1378/chest.102.4.1145

Chest

Volume 102, Issue 4, October 1992, Pages 1145-1151

https://doi.org/10.1378/chest.102.4.1145 Get rights and content

To assess the accuracy of the respiratory inductive plethysmograph (RIP) during sleep in obese patients with obstructive sleep apnea (OSA), we monitored 13 patients with OSA during wakefulness and nocturnal sleep with simultaneous measurements of tidal volume from RIP and integrated airflow. Patients wore a tightly fitting face mask with pneumotachograph during wakefulness and sleep. Calibrations were performed during wakefulness prior to sleep and compared with subsequent wakeful calibrations at the end of the study. Patients maintained the same posture during sleep (supine, 11; lateral, two) as during calibrations. There were no significant differences in calibrations before sleep and after awakening. The mean error in 13 patients undergoing RIP measurements of tidal volume during wakefulness was – 0.7 ± 3.4 percent while that during sleep was 2.1 ±14.9 percent (p<0.001). The standard deviation (SD) of the differences between individual breaths measured by RIP and integrated airflow was 9.8 ±5.5 percent during wakefulness and 25.5 ±18.6 percent during sleep (p<0.001). During both wakefulness and sleep, errors in RIP tidal volume were not significantly correlated with body mass index. In 12 patients with at least 10 percent time in each of stages 1 and 2 sleep, SD was greater in stage 2 sleep compared with wakefulness and stage 1 (p<0.001). In three patients who manifested all stages of sleep, SD was greater in REM sleep than in wakefulness and all stages of non-REM sleep (p<0.001). In three patients who manifested all stages of sleep, SD was greater in REM sleep than in wakefulness and all stages of non REM sleep (p<0.001). This was associated with paradoxic motion of the rib cage in two patients during REM. We conclude that, despite increased errors in individual breath measurements during sleep, more marked during stages 2 and REM sleep, RIP is clinically useful to measure ventilation quantitatively in obese patients with sleep apnea. The criterion of a decrease of 50 percent in tidal volume assessed by RIP is appropriate to define hypopneas in such patients.

Section snippets

Patients

Twenty consecutive patients presenting to the sleep laboratory of the Antoine Beclere Hospital with a history suggestive of sleep apnea syndrome were requested to participate in the study. After informed written consent was obtained, all patients underwent overnight polysomnographic (PSG) studies. Neither sedatives nor hypnoptics were used; and six patients were unable to sleep without substantial disruption due to intolerance of the face mask. An additional patient tolerated the study well,

RESULTS

Calibrations before sleep and after awakening were acceptably accurate in all patients. Prior to sleep onset, RIP-derived volumes were within 5 percent of integrated airflow in 11 of 13 patients and within 9.1 percent in 2 of 13. Calibrations performed prior to sleep onset and after awakening were within 5 percent of each other in 6 of 13 patients and within 9.6 percent in 7 of 13. Figure 1 shows a representative series of calibration breaths in one patient. Thoracic displacement divided by

DISCUSSION

The present study shows that use of the RIP in obese patients with sleep apnea syndrome (SAS) is acceptably accurate for estimating minute ventilation during wakefulness. Accuracy of our measurements using the method of linear calibration is comparable to that previously reported for nonobese subjects.3, 6, 10, 15 A recent study in young normal subjects showed a bias (algebraic difference between RIP- and pneumotachygraph-derived volumes) two to eight times larger than in the present study,

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Citation Excerpt :
However, the role of obesity in the accuracy of RIP measures was unclear in the study of Zhang et al. (2001), because normal-weight, overweight and obese individuals with sleep-disordered breathing were combined into one group. In addition, paired measures were obtained during sleep, and hence the presence of apnoeas/hypopnoeas may have influenced the validity of RIP measures (Cantineau et al., 1992). Therefore, the influence of obesity on the validity of RIP requires specific investigation, particularly among people with OHS.
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Accuracy of Respiratory Inductive Plethysmography during Wakefulness and Sleep in Patients with Obstructive Sleep Apnea

Section snippets

Patients

RESULTS

DISCUSSION

Chest

Chest

Chest

Relative contributions of rib cage and abdomen to breathing in normal subjects.

J Appl Physiol

Single-position calibration of the respiratory inductance plethysmograph.

J Appl Physiol

Calibration of respiratory inductive plethysmograph during natural breathing.

J Appl Physiol

Accuracy of respiratory inductive plethysmograph over wide range of rib cage and abdominal compartmental contribution to tidal volume in normal subjects and in patients with chronic obstructive pulmonary disease.

Am Rev Respir Dis

Validation of respiratory inductive plethysmography using different calibration procedures.

Am Rev Respir Dis

Measurement of the separate volume changes of rib cage and abdomen during breathing.

J Appl Physiol

Non-invasive measurement of ventilation during exercise using a respiratory inductive plethysmograph.

Am Rev Respir Dis

Breathing abnormalities during sleep.

Arch Intern Med

Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea.

J Appl Physiol

Effect of quiet sleep in humans on resting and CO2 stimulated breathing.

J Appl Physiol

The sleep hypopnea syndrome.

Am Rev Respir Dis

Effect of quiet sleep in humans on resting and CO₂ stimulated breathing.