PDF herunterladen
Sleep Breath 2004; 08(2): 73-83
DOI: 10.1055/s-2004-829635
ORIGINAL ARTICLE

Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Upper Airway Structural Changes on Central Chemosensitivity in Obstructive Sleep Apnea-Hypopnea

Masaaki Suzuki1 , Hiromasa Ogawa2 , Shinichi Okabe2 , Tomoko Yagi3 , Atsushi Horiuchi4 , Mau Okubo4 , Katsuhisa Ikeda1 , 5 , Wataru Hida6 , Toshimitsu Kobayashi1
  • 1Departments of Otorhinolaryngology-Head and Neck Surgery
  • 2Respiratory and Infectious Diseases, Tohoku University Graduate School of Medicine, Sendai, Japan
  • 3Sleep Disorders Laboratory, Ohta General Hospital, Kawasaki, Japan
  • 4Department of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
  • 5Department of Otolaryngology, Juntendo University School of Medicine, Tokyo, Japan
  • 6Department of Health Informatics, Tohoku University Graduate School of Information Science, Sendai, Japan
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
21. Juni 2004 (online)

   Lizenzen und Reprints

We examined the efficiency of upper airway structural changes in uvulopalatopharyngoplasty and/or tonsillectomy on central chemosensitivity, and whether the outcome of such surgeries can be predicted by the central chemosensitivity in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients. In 11 patients with OSAHS group, the average of the hypercapnic ventilatory response (HCVR) slope was 1.93 ± 0.20 L/min/mm Hg preoperatively and 1.78 ± 0.22 L/min/mm Hg postoperatively. The average of the mouth occlusion pressure at 0.1 second after the onset of inspiration (P0.1) slope was 0.47 ± 0.06 cm H2O/mm Hg and 0.44 ± 0.08 cm H2O/mm Hg, before and after surgery, respectively. There were no significant differences before and after treatment, although OSAHS was improved by these surgeries. In control group with 5 patients, the HCVR slope and P0.1 slope also showed no significant difference before and after the procedure. When we divided the 11 OSAHS patients into 7 responders (apnea-hypopnea index < 20 events/h and > 50% reduction) and 4 poor responders, there was a significant difference between the average HCVR slope of responders (1.59 ± 0.21 L/min/mm Hg) and that of poor responders (2.52 ± 0.20 L/min/mm Hg). We saw no significant difference in physiologic (age, body mass index, one-piece tonsil weight), blood gas values, cephalometric, spirometric, or sleep parameters.

KEYWORDS

Obstructive sleep apnea-hypopnea syndrome - central chemosensitivity - hypercapnic ventilatory response - uvulopalatopharyngoplasty

REFERENCES

  • 1 Cistulli P A, Sullivan C E. Pathophysiology of Sleep Apnea. In: Saunders NA, Sullivan CE Sleep and Breathing. 2nd ed. New York; Marcel Dekker 1994: 405-448
    Suche in Google Scholar
  • 2 Kubin L, Davis R O. Mechanisms of airway hypotonia. In: Pack AI Sleep Apnea Pathogenesis, Diagnosis, and Treatment. New York; Marcel Dekker 2002: 99-154
    Suche in Google Scholar
  • 3 Tun Ye, Hida W, Okabe S et al.. Effects of nasal continuous positive airway pressure on awake ventilatory responses to hypoxia and hypercapnia in patients with obstructive sleep apnea.  Tohoku J Exp Med. 2000;  190 157-168
    CrossrefPubMedSuche in Google Scholar
  • 4 Han F, Chen E, Wei H et al.. Treatment effects on carbon dioxide retention in patients with obstructive sleep apnea-hypopnea syndrome.  Chest. 2001;  119 1814-1819
    CrossrefPubMedSuche in Google Scholar
  • 5 Guilleminault C, Cummiskey J. Progressive improvement of apnea index and ventilatory response to CO2 after tracheostomy in obstructive sleep apnea syndrome.  Am Rev Respir Dis. 1982;  126 14-20
    PubMedSuche in Google Scholar
  • 6 Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing.  Otolaryngol Head Neck Surg. 2002;  127 13-21
    CrossrefPubMedSuche in Google Scholar
  • 7 Riley R W, Powell N B, Guilleminault C. Obstructive sleep apnea syndrome. a review of 306 consecutively treated surgical patients.  Otolaryngol Head Neck Surg. 1993;  108 117-125
    PubMedSuche in Google Scholar
  • 8 , [No authors listed.] The report of an American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research.  Sleep. 1999;  22 667-689
    PubMedSuche in Google Scholar
  • 9 Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Technique and Scoring System for Sleep Stages of Human Sleep. Los Angeles; Brain Information Service 1968: 204
    Suche in Google Scholar
  • 10 Read D JC. A clinic method for assessing the ventilation response to CO2 .  Australas Ann Med. 1967;  16 20-32
    PubMedSuche in Google Scholar
  • 11 Satoh M, Hida W, Chonan T et al.. Effects of posture on carbon dioxide responsiveness in patients with obstructive sleep apnea.  Thorax. 1993;  48 537-541
    PubMedSuche in Google Scholar
  • 12 Whitelaw W, Derenne J Ph, Mlic-Emili J. Occlusion pressure as a measure of respiratory center output in conscious man.  Respir Physiol. 1975;  23 181-189
    CrossrefPubMedSuche in Google Scholar
  • 13 Friedman M, Landsberg R, Tanyeri H. Submucosal Uvulopalatopharyngoplasty.  Op Techi Otolaryngol Head Neck Surg. 2000;  11 26-29
    PubMedSuche in Google Scholar
  • 14 Shin D D, Jones R L, Man G C. Hypercapnic ventilatory response in patients with and without obstructive sleep apnea. Do age, gender, obesity, and daytime PaCO2 matter?.  Chest. 2000;  117 454-459
    CrossrefPubMedSuche in Google Scholar
  • 15 Wilcox I, McNamara S G, Dodd M J, Sullivan C E. Ventilatory control in patients with sleep apnea and left ventricular dysfunction: comparison of obstructive and central sleep apnea.  Eur Respir J. 1998;  11 7-13
    CrossrefPubMedSuche in Google Scholar
  • 16 Solin P, Roebuck T, Johns D P, Walters E H, Naughton M T. Peripheral and central ventilatory responses in central sleep apnea with and without congestive heart failure.  Am J Respir Crit Care Med. 2000;  162 2194-2200
    PubMedSuche in Google Scholar
  • 17 Sforza E, Boudewijns A, Schenedecker B, Zamagni M, Krieger J. Role of chemosensitivity in intrathoracic pressure changes during obstructive sleep apnea.  Am J Respir Crit Care Med. 1996;  154 1741-1747
    PubMedSuche in Google Scholar
  • 18 Chapman K R, Bruce E N, Gothe B, Cherniack N S. Possible mechanisms of periodic breathing during sleep.  J Appl Physiol. 1988;  64 1000-1008
    PubMedSuche in Google Scholar
  • 19 Verbraecken J, Willemen M, Cock W D, Van de Heyning P, De Backer W. Relationship between CO2 drive and characteristics of apneas in obstructive and central sleep apnea.  Respir Physiol. 1998;  114 185-194
    CrossrefPubMedSuche in Google Scholar
  • 20 Khoo M CK, Kronauer R E, Strohl K P, Slutsky A S. Factors inducing periodic breathing in humans: a general model.  J Appl Physiol. 1982;  53 644-659
    PubMedSuche in Google Scholar
  • 21 Asyali M H, Berry R B, Khoo M C. Assessment of closed-loop ventilatory stability in obstructive sleep apnea.  IEEE Trans Biomed Eng. 2002;  49 206-216
    CrossrefPubMedSuche in Google Scholar
  • 22 Hudgel D W, Gordon E A, Thanakitcharu S, Bruce E N. Instability of ventilatory control in patients with obstructive sleep apnea.  Am J Respir Crit Care Med. 1998;  158 1142-1149
    PubMedSuche in Google Scholar
  • 23 Younwa M, Ostrowski M, Thompson W, Leslie C, Shewchuk W. Chemical control stability in patients with obstructive sleep apnea.  Am J Respir Crit Care Med. 2001;  163 1181-1190
    PubMedSuche in Google Scholar

Masaaki SuzukiM.D. 

Department of Otolaryngology, Teikyo University School of Medicine

2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan

eMail: suzukima@med.teikyo-u.acjp