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Exhaled nitric oxide from the central airway and alveoli in OSAHS patients: the potential correlations and clinical implications

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Abstract

Background

The aim of the study was to evaluate exhaled nitric oxide (eNO) derived from different areas of airway in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with NO exchange model and investigate the potential application and interpretation of eNO in clinical setting.

Methods

This study was divided into two parts. Firstly, we performed a case control study in 32 OSAHS patients and 27 non-OSAHS participants. Fractional eNO (FeNO) and eNO from the central airway (J’awNO) and from alveoli (CANO) were compared in OSAHS and control groups. Also, correlation of eNO to severity of OSAHS was analyzed. Secondly, a prospective study was conducted in 30 severe OSAHS patients who received a short-term nasal continuous positive airway pressure (nCPAP) treatment. We evaluated eNO, plasma ET-1 concentration, and echocardiography during the treatment process and explored the potential relationship among them.

Results

FeNO and J’awNO were higher in OSAHS and associated with disease severity, while CANO was relatively lower. After nCPAP treatment in severe OSAHS patients, FeNO and J’awNO decreased and CANO increased significantly. Substantial agreement was shown between the elevation of CANO and the decrease of plasma ET-1 concentration after nCPAP by Kappa analysis for consistency. Tei index, which is considered indicative of global right ventricular function, might be predicted by plasma ET-1 levels in severe OSAHS patients.

Conclusions

NO exchange model provides us with more information of eNO derived from different areas. eNO is not only confirmed to be an effective method for airway inflammation evaluation in the follow-up of OSAHS, CANO may also serve as a useful marker in monitoring endothelial function, resistance of pulmonary circulation, and right ventricular function for clinical implication.

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Conflict of interest

The authors declare that they have no competing interests.

Funding

This research was supported by the Shanghai Leading Academic Discipline Project (B115), National Natural Science Foundation of China (81400043, 81100048, 81300055), Key Medical Grant from Shanghai Science and Technology Committee (13430720500), and Grant from Ministry of Education of China (20130071110044).

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    Authors and Affiliations

    1. Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032

      Jie Liu, Zilong Liu, Fen Zhu, Wenjing Li, Hong Jiang, Xiaodan Wu, Yuanlin Song, Shanqun Li & Chunxue Bai

    2. Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China

      Jie Liu, Zilong Liu, Fen Zhu, Wenjing Li, Hong Jiang, Xiaodan Wu, Shanqun Li & Chunxue Bai

    3. Shanghai Respiratory Research Institute, Shanghai, China

      Jie Liu, Zilong Liu, Fen Zhu, Wenjing Li, Hong Jiang, Xiaodan Wu, Yuanlin Song, Shanqun Li & Chunxue Bai

    4. Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China

      Zheng Li

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    1. Jie Liu
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    Correspondence to Chunxue Bai.

    Additional information

    Yuanlin Song, Shanqun Li and Chunxue Bai contributed equally to this work.

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    Liu, J., Li, Z., Liu, Z. et al. Exhaled nitric oxide from the central airway and alveoli in OSAHS patients: the potential correlations and clinical implications. Sleep Breath 20, 145–154 (2016). https://doi.org/10.1007/s11325-015-1198-7

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    • DOI: https://doi.org/10.1007/s11325-015-1198-7

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