Sleep and Breathing

, Volume 9, Issue 1, pp 12–19

Effect of CPAP treatment on inspiratory arousal threshold during NREM sleep in OSAS

  • José Haba-Rubio
  • Emilia Sforza
  • Thomas Weiss
  • Carmen Schröder
  • Jean Krieger
Original Article

Abstract

The maximal inspiratory effort recorded at the end of apnea has been considered as an index of arousal threshold in obstructive sleep apnea syndrome (OSAS). Previous investigations have shown that the arousal threshold is higher in patients with OSAS than in normal subjects. The aim of the present study was to investigate the effect of continuous positive airway pressure (CPAP) treatment on the inspiratory-effort-related arousal threshold in patients with OSAS. In ten male patients, 40 episodes of apnea during stage 2 non-REM (NREM) sleep were analyzed. Apnea duration (t), esophageal pressure (Pes) at the first occluded breath (Pes1), the minimum of the three initial Pes swings (Pes min), the maximum of the three final Pes swings (Pes Max), ΔPes (Pes Max−Pes min), RPes (rate of increase of intrathoracic pressure, ΔPes/t), n (number of occluded breaths during apnea), ΔPes/n, n/t, and SaO2 were determined before and after occlusion. These apneic episodes were compared to ten episodes of apnea provoked by a mask occlusion device after 1, 7, 30, and 90 days of CPAP treatment. The therapy resulted in a decrease in the inspiratory-effort-related arousal threshold, as measured by a reduction of Pes Max, without significant changes in apnea duration and apnea-related hypoxemia. Pes1 and ΔPes/n, which are markers of respiratory drive, significantly decreased between observations. CPAP treatment decreases the inspiratory-effort-related arousal threshold and induces a decrease in ventilatory drive in response to upper airway occlusion.

Keywords

Obstructive sleep apnea Arousal Continuous positive airway pressure 

References

  1. 1.
    Martin RJ, Pennock BE, Orr WC, Sanders MH, Rogers RM (1980) Respiratory mechanics and timing during sleep in occlusive sleep apnea. J Appl Physiol 48:432–437Google Scholar
  2. 2.
    Onal E, Leech JA, Lopata M (1985) Dynamics of respiratory drive and pressure during NREM sleep in patients with occlusive apnea. J Appl Physiol 58:1971–1974Google Scholar
  3. 3.
    Rees K, Spence DPS, Calverley PMA (1994) Pleural and transdiaphragmatic pressure swings during obstructive apneas in patients with OSA. Am J Respir Crit Care Med 149:A926Google Scholar
  4. 4.
    Phillipson EA, Sullivan CE (1978) Arousal: the forgotten response to respiratory stimuli. Am Rev Respir Dis 118:807–809Google Scholar
  5. 5.
    Remmers JE, deGroot WJ, Sauerland EK, Anch AM (1978) Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 44:931–938Google Scholar
  6. 6.
    Berry RB, Bonnet MH, Light RW (1992) Effect of ethanol on the arousal response to airway occlusion during sleep in normal subjects. Am Rev Respir Dis 145:445–452Google Scholar
  7. 7.
    Scrima L, Broudy M, Nay KN, Cohn MA (1982) Increased severity of obstructive sleep apnea after bedtime alcohol ingestion: diagnostic potential and proposed mechanism of action. Sleep 5:318–328Google Scholar
  8. 8.
    Issa FG, Sullivan CE (1982) Alcohol, snoring and sleep apnea. J Neurol Neurosurg Psychiatry 45:353–359Google Scholar
  9. 9.
    Berry RB, McCasland CR, Light RW (1992) The effect of triazolam on the arousal response to airway occlusion during sleep in normal subjects. Am Rev Respir Dis 146:1256–1260Google Scholar
  10. 10.
    Berry RB, Kouchi K, Bower J, Prosise G, Light RW (1995) Triazolam in patients with obstructive sleep apnea. Am J Respir Crit Care Med 151:450–454Google Scholar
  11. 11.
    Guilleminault C, Rosekind M (1981) The arousal threshold: sleep deprivation, sleep fragmentation, and obstructive sleep apnea syndrome. Bull Eur Physiopathol Respir 17:341–349Google Scholar
  12. 12.
    Persson HE, Svanborg E (1996) Sleep deprivation worsens obstructive sleep apnea: comparison between diurnal and nocturnal polysomnography. Chest 109:645–650Google Scholar
  13. 13.
    Basner RC, Onal E, Carley DW, Stepanski EJ, Lopata M (1995) Effect of induced transient arousal on obstructive apnea duration. J Appl Physiol 78:1469–1476Google Scholar
  14. 14.
    Phillipson EA, Sullivan CE (1982) Ventilatory and arousal responses to hypoxia in sleeping humans. Am Rev Respir Dis 125:632–639Google Scholar
  15. 15.
    Ringler J, Basner RC, Shannon R, Manning H, Weinberger SE, Weiss JW (1990) Hypoxemia alone does not explain blood pressure elevations after obstructive apneas. J Appl Physiol 69:2143–2148Google Scholar
  16. 16.
    Berthon-Jones M, Sullivan CE (1984) Ventilation and arousal responses to hypercapnia in normal sleeping humans. J Appl Physiol 57:59–67Google Scholar
  17. 17.
    Douglas NJ, White DP, Weil JV, Pickett CK, Zwillich CW (1982b) Hypercapnic ventilatory response in sleeping adults. Am Rev Respir Dis 126:758–762Google Scholar
  18. 18.
    Vincken W, Guilleminault C, Silvestri L, Cosio M, Grassino A (1987) Inspiratory muscle activity as a trigger causing the airways to open in obstructive sleep apnea. Am Rev Respir Dis 135:372–377Google Scholar
  19. 19.
    Gleeson K, Zwillich CW, White DP (1989) Arousal from sleep in response to ventilatory stimuli occurs at a similar degree of ventilatory effort irrespective of the stimulus. Am Rev Respir Dis 142:295–300Google Scholar
  20. 20.
    Wilcox PG, Paré PD, Road JD, Fleetham JA (1990) Respiratory muscle function during obstructive sleep apnea. Am Rev Respir Dis 142:533–539Google Scholar
  21. 21.
    Kimoff RJ, Cheong TH, Olha AE, Charbonneau M, Levy RD, Cosio MG, Gottfried SB (1994) Mechanisms of apnea termination in obstructive sleep apnea. Role of chemoreceptor and mechanoreceptor stimuli. Am J Respir Crit Care Med 149:707–714Google Scholar
  22. 22.
    Gleeson K, Zwillich CW, White DP (1990) The influence of increasing ventilatory effort on arousal from sleep. Am Rev Respir Dis 142:295–300Google Scholar
  23. 23.
    Charbonneau M, Marin JM, Olha A, Kimoff RJ, Levy RD, Cosio MG (1994) Changes in obstructive sleep apnea characteristics through the night. Chest 106:1695–1701Google Scholar
  24. 24.
    Montserrat JM, Kosmas EN, Cosio MG, Kimoff RJ (1996) Mechanisms of apnea lengthening across the night in obstructive sleep apnea. Am J Respir Crit Care Med 154:993–995Google Scholar
  25. 25.
    Sforza E, Krieger J, Petiau C (1998) Nocturnal evolution of respiratory effort in obstructive sleep apnoea syndrome: influence on arousal threshold. Eur Respir 12:1257–1263Google Scholar
  26. 26.
    Berry RB, Kouchi KG, Der DE, Dickel MJ, Light RW (1996) Sleep apnea impairs the arousal response to airway occlusion. Chest 109:1490–1496Google Scholar
  27. 27.
    Carskadon MA, Dement WC, Mitler MM, Roth T, Westbrook PR, Keenan S (1986) Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep 9:519–524Google Scholar
  28. 28.
    Johns MW (1991) A new method for measuring daytime sleepiness—the Epworth Sleepiness Scale. Sleep 14:540–545Google Scholar
  29. 29.
    Rechtschaffen A, Kales A (eds) (1968) A manual of standardized terminology, technique and scoring system for sleep stages of human sleep. Brain Information Service/Brain Research Institute, Los AngelesGoogle Scholar
  30. 30.
    ASDA (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–689Google Scholar
  31. 31.
    ASDA (1992) EEG arousals: scoring rules and examples. Sleep 15(2):174–184Google Scholar
  32. 32.
    Ryan T, Mlynczak S, Erickson T, Man SF, Man GC (1989) Oxygen consumption during sleep: influence of sleep stage and time of night. Sleep 12(3):201–210Google Scholar
  33. 33.
    Xi L, Smith CA, Saupe KW, Henderson KS, Dempsey JA (1993) Effects of rapid-eye-movement sleep on the apneic threshold in dogs. J Appl Physiol 75(3):1129–1139Google Scholar
  34. 34.
    Xi L, Chow CM, Smith CA, Dempsey JA (1994) Effects of REM sleep on the ventilatory response to airway occlusion in the dog. Sleep 17(8):674–687Google Scholar
  35. 35.
    Sforza E, J Krieger, W Bacon, Petiau C, Zamagni M, Boudewijns A (1995) Determinants of effective continuous positive airway pressure in obstructive sleep apnea. Role of respiratory effort. Am J Respir Crit Care Med 151:1852–1856Google Scholar
  36. 36.
    Downey R, Bonnet MH (1987) Performance during frequent sleep disruption. Sleep 10:354–363Google Scholar
  37. 37.
    Phillipson EA, Bowes G, Sullivan CE, Woolf GM (1980) The influence of sleep fragmentation on arousal and ventilatory responses to respiratory stimuli. Sleep 3:281–288Google Scholar
  38. 38.
    Fewell JE (1987) The effect of short-term sleep fragmentation produced by intense auditory stimuli on the arousal response to upper airway obstruction in lambs. J Dev Physiol 9:409–417Google Scholar
  39. 39.
    O’Donnell CP, King ED, Schwartz AR, Smith PL, Robotham JL (1994) Effect of sleep deprivation on responses to airway obstruction in the sleeping dog. J Appl Physiol 77:1811–1818Google Scholar
  40. 40.
    Wiegaud L, Zwillich C, White D (1988) Sleep and the ventilatory response to resistive loading in normal man. J Appl Physiol 64:1186–1195Google Scholar
  41. 41.
    Chen Z, Eldridge FL, Wagner PG (1991) Respiratory associated rhythmic firing of midbrain neurons in cats: relation to level of respiratory drive. J Physiol 437:305–325Google Scholar
  42. 42.
    Svanborg E, Larson H (1993) Development of nocturnal respiratory disturbance in untreated patients with obstructive sleep apnea syndrome. Chest 104:340–343Google Scholar
  43. 43.
    Pendlebury ST, Pépin JL, Veale D, Levy P (1997) Natural evolution of moderate sleep apnoea syndrome: significant progression over a mean of 17 months. Thorax 52:872–878Google Scholar
  44. 44.
    Lugaresi E, Cirignotta F, Gerardi R, Montagna P (1990) Snoring and sleep apnea: natural history of heavy snorers disease. In: Guilleminault C, Partinen M (eds) Obstructive sleep apnea syndrome: clinical research and treatment. Raven, New York, pp 25–36Google Scholar
  45. 45.
    Berry RB, Asyali MA, McNellis MI, Khoo MC (1998) Within-night variation in respiratory effort preceding apnea termination and EEG delta power in sleep apnea. J Appl Physiol 85(4):1434–1441Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • José Haba-Rubio
    • 1
  • Emilia Sforza
    • 1
  • Thomas Weiss
    • 1
  • Carmen Schröder
    • 1
  • Jean Krieger
    • 1
    • 2
  1. 1.Sleep Disorders UnitUniversity HospitalStrasbourgFrance
  2. 2.Clinique NeurologiqueStrasbourgFrance

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