Sleep and Breathing

, Volume 17, Issue 2, pp 845–852

Breathing irregularity during wakefulness associates with CPAP acceptance in sleep apnea

  • Motoo Yamauchi
  • Frank J. Jacono
  • Yukio Fujita
  • Masanori Yoshikawa
  • Yoshinobu Ohnishi
  • Hiroshi Nakano
  • Cara K. Campanaro
  • Kenneth A. Loparo
  • Kingman P. Strohl
  • Hiroshi Kimura
Original Article



Individuals have different breathing patterns at rest, during wakefulness, and during sleep, and patients with sleep apnea are no different. The hypothesis for this study was that breathing irregularity during wakefulness associates with CPAP acceptance in obstructive sleep apnea (OSA).


From a 2007–2010-database of patients with a diagnostic polysomnography (PSG) and prescribed CPAP (n = 380), retrospectively, 66 patients who quit CPAP treatment at 6 months were identified. Among them, 27 OSA patients quit despite having no side effects for discontinuing CPAP (Group A) and were compared to a matched group (age, body mass index, and apnea–hypopnea index) with good 6-month CPAP adherence (Group B; n = 21). Five minutes of respiratory signal during wakefulness at the initial PSG were extracted from respiratory inductance plethysmography recordings, and measured in a blinded fashion. The coefficients of variation (CV) for the breath-to-breath inspiration time (Ti), expiration time (Te), Ti + Te (Ttot), and relative tidal volume, as well as an independent information theory-based metric of signal pattern variability (mutual information) were compared between groups.


The CV for tidal volume was significantly greater (p = 0.001), and mutual information was significantly lower (p = 0.041) in Group A as compared to Group B.


Differences in two independent measures of breathing irregularity correlated with CPAP rejection in OSA patients without nasal symptoms or comorbidity. Prospective studies of adherence should examine traits of breathing stability.


Obstructive sleep apnea CPAP adherence Respiratory control Nonlinear analysis 


  1. 1.
    Shea SA, Guz A (1992) Personnalite ventilatoire—an overview. Respir Physiol 87(3):275–291PubMedCrossRefGoogle Scholar
  2. 2.
    Shea SA, Benchetrit G, Pham Dinh T, Hamilton RD, Guz A (1989) The breathing patterns of identical twins. Respir Physiol 75(2):211–223PubMedCrossRefGoogle Scholar
  3. 3.
    Kawakami Y, Yamamoto H, Yoshikawa T, Shida A (1984) Chemical and behavioral control of breathing in adult twins. Am Rev Respir Dis 129(5):703–707PubMedGoogle Scholar
  4. 4.
    Cherniack NS (1981) Respiratory dysrhythmias during sleep. N Engl J Med 305(6):325–330PubMedCrossRefGoogle Scholar
  5. 5.
    Yamauchi M, Tamaki S, Yoshikawa M, Ohnishi Y, Nakano H, Jacono FJ, Loparo KA, Strohl KP, Kimura H (2011) Differences in breathing patterning during wakefulness in patients with mixed apnea-dominant vs obstructive-dominant sleep apnea. Chest 140(1):54–61PubMedCrossRefGoogle Scholar
  6. 6.
    Basoglu OK, Midilli M, Midilli R, Bilgen C (2011) Adherence to continuous positive airway pressure therapy in obstructive sleep apnea syndrome: effect of visual education. Sleep BreathGoogle Scholar
  7. 7.
    Shapiro GK, Shapiro CM (2010) Factors that influence CPAP adherence: an overview. Sleep Breath 14(4):323–335PubMedCrossRefGoogle Scholar
  8. 8.
    Yetkin O, Kunter E, Gunen H (2008) CPAP compliance in patients with obstructive sleep apnea syndrome. Sleep Breath 12(4):365–367PubMedCrossRefGoogle Scholar
  9. 9.
    Gay P, Weaver T, Loube D, Iber C (2006) Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 29(3):381–401PubMedGoogle Scholar
  10. 10.
    Sin DD, Mayers I, Man GC, Pawluk L (2002) Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest 121(2):430–435PubMedCrossRefGoogle Scholar
  11. 11.
    Budhiraja R, Parthasarathy S, Drake CL, Roth T, Sharief I, Budhiraja P, Saunders V, Hudgel DW (2007) Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep 30(3):320–324PubMedGoogle Scholar
  12. 12.
    Weaver TE, Grunstein RR (2008) Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 5(2):173–178PubMedCrossRefGoogle Scholar
  13. 13.
    Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A, Tal A, Tarasiuk A (2009) Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment. Sleep 32(4):545–552PubMedGoogle Scholar
  14. 14.
    Platt AB, Field SH, Asch DA, Chen Z, Patel NP, Gupta R, Roche DF, Gurubhagavatula I, Christie JD, Kuna ST (2009) Neighborhood of residence is associated with daily adherence to CPAP therapy. Sleep 32(6):799–806PubMedGoogle Scholar
  15. 15.
    Wild MR, Engleman HM, Douglas NJ, Espie CA (2004) Can psychological factors help us to determine adherence to CPAP? a prospective study. Eur Respir J 24(3):461–465PubMedCrossRefGoogle Scholar
  16. 16.
    Shannon CE (1997) The mathematical theory of communication. 1963. MD Comput 14(4):306–317PubMedGoogle Scholar
  17. 17.
    Fraser AM, Swinney HL (1986) Independent coordinates for strange attractors from mutual information. Phys Rev A 33(2):1134–1140PubMedCrossRefGoogle Scholar
  18. 18.
    Koo BB, Strohl KP, Gillombardo CB, Jacono FJ (2010) Ventilatory patterning in a mouse model of stroke. Respir Physiol Neurobiol 172(3):129–135PubMedCrossRefGoogle Scholar
  19. 19.
    Dhingra RR, Jacono FJ, Fishman M, Loparo KA, Rybak IA, Dick TE (2011) Vagal-dependent nonlinear variability in the respiratory pattern of anesthetized, spontaneously breathing rats. J Appl Physiol 111(1):272–284PubMedCrossRefGoogle Scholar
  20. 20.
    Jacono FJ, De Georgia MA, Wilson CG, Dick TE, Loparo KA (2010) Data acquisition and complex systems analysis in critical care: developing the intensive care unit of the future. J Healthc Eng 1(3):337–355CrossRefGoogle Scholar
  21. 21.
    Kerr AM (1992) A review of the respiratory disorder in the Rett syndrome. Brain Dev 14(Suppl):S43–S45PubMedGoogle Scholar
  22. 22.
    Ogier M, Katz DM (2008) Breathing dysfunction in Rett syndrome: understanding epigenetic regulation of the respiratory network. Respir Physiol Neurobiol 164(1–2):55–63PubMedCrossRefGoogle Scholar
  23. 23.
    Eckert DJ, Jordan AS, Merchia P, Malhotra A (2007) Central sleep apnea: pathophysiology and treatment. Chest 131(2):595–607PubMedCrossRefGoogle Scholar
  24. 24.
    Netzer NC, Strohl KP (1999) Sleep and breathing in recreational climbers at an altitude of 4200 and 6400 meters: observational study of sleep and patterning of respiration during sleep in a group of recreational climbers. Sleep Breath 3(3):75–82PubMedCrossRefGoogle Scholar
  25. 25.
    Pattinson KT (2008) Opioids and the control of respiration. Br J Anaesth 100(6):747–758PubMedCrossRefGoogle Scholar
  26. 26.
    Teichtahl H, Wang D (2007) Sleep-disordered breathing with chronic opioid use. Expert Opin Drug Saf 6(6):641–649PubMedCrossRefGoogle Scholar
  27. 27.
    Bradley TD, Floras JS (2003) Sleep apnea and heart failure: Part II: central sleep apnea. Circulation 107(13):1822–1826PubMedCrossRefGoogle Scholar
  28. 28.
    Caples SM, Garcia-Touchard A, Somers VK (2007) Sleep-disordered breathing and cardiovascular risk. Sleep 30(3):291–303PubMedGoogle Scholar
  29. 29.
    Leung RS, Bradley TD (2001) Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med 164(12):2147–2165PubMedCrossRefGoogle Scholar
  30. 30.
    Cherniack NS, Longobardo G, Evangelista CJ (2005) Causes of Cheyne-Stokes respiration. Neurocrit Care 3(3):271–279PubMedCrossRefGoogle Scholar
  31. 31.
    Hardavella G, Stefanache F, Ianovici N (2006) Cheyne stokes respiration in stroke patients. Rev Med Chir Soc Med Nat Iasi 110(1):82–87PubMedGoogle Scholar
  32. 32.
    Han F, Subramanian S, Dick TE, Dreshaj IA, Strohl KP (2001) Ventilatory behavior after hypoxia in C57BL/6J and A/J mice. J Appl Physiol 91(5):1962–1970PubMedGoogle Scholar
  33. 33.
    Han F, Subramanian S, Price ER, Nadeau J, Strohl KP (2002) Periodic breathing in the mouse. J Appl Physiol 92(3):1133–1140PubMedGoogle Scholar
  34. 34.
    Yamauchi M, Dostal J, Kimura H, Strohl KP (2008) Effects of buspirone on posthypoxic ventilatory behavior in the C57BL/6J and A/J mouse strains. J Appl Physiol 105(2):518–526PubMedCrossRefGoogle Scholar
  35. 35.
    Yamauchi M, Ocak H, Dostal J, Jacono FJ, Loparo KA, Strohl KP (2008) Post-sigh breathing behavior and spontaneous pauses in the C57BL/6J (B6) mouse. Respir Physiol Neurobiol 162(2):117–125PubMedCrossRefGoogle Scholar
  36. 36.
    Perez-Padilla R, West P, Kryger MH (1983) Sighs during sleep in adult humans. Sleep 6(3):234–243PubMedGoogle Scholar
  37. 37.
    Baldwin DN, Suki B, Pillow JJ, Roiha HL, Minocchieri S, Frey U (2004) Effect of sighs on breathing memory and dynamics in healthy infants. J Appl Physiol 97(5):1830–1839PubMedCrossRefGoogle Scholar
  38. 38.
    Vlemincx E, Taelman J, De Peuter S, Van Diest I, Van den Bergh O (2011) Sigh rate and respiratory variability during mental load and sustained attention. Psychophysiology 48(1):117–120PubMedCrossRefGoogle Scholar
  39. 39.
    Vlemincx E, Van Diest I, De Peuter S, Bresseleers J, Bogaerts K, Fannes S, Li W, Van Den Bergh O (2009) Why do you sigh? Sigh rate during induced stress and relief. Psychophysiology 46(5):1005–1013PubMedCrossRefGoogle Scholar
  40. 40.
    Wuyts R, Vlemincx E, Bogaerts K, Van Diest I, Van den Bergh O (2011) Sigh rate and respiratory variability during normal breathing and the role of negative affectivity. Int J Psychophysiol 82(2):175–179PubMedCrossRefGoogle Scholar
  41. 41.
    Wellman A, Eckert DJ, Jordan AS, Edwards BA, Passaglia CL, Jackson AC, Gautam S, Owens RL, Malhotra A, White DP (2011) A method for measuring and modeling the physiological traits causing obstructive sleep apnea. J Appl Physiol 110(6):1627–1637PubMedCrossRefGoogle Scholar
  42. 42.
    Shannon CE, Weaver W (1949) The mathematical theory of communication. University of Illinois Press, UrbanaGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Motoo Yamauchi
    • 1
  • Frank J. Jacono
    • 2
    • 3
  • Yukio Fujita
    • 1
  • Masanori Yoshikawa
    • 1
  • Yoshinobu Ohnishi
    • 4
  • Hiroshi Nakano
    • 5
  • Cara K. Campanaro
    • 2
    • 3
  • Kenneth A. Loparo
    • 6
  • Kingman P. Strohl
    • 2
    • 3
  • Hiroshi Kimura
    • 1
  1. 1.Second Department of Internal Medicine (Department of Respiratory Medicine)Nara Medical UniversityNaraJapan
  2. 2.Division of Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityClevelandUSA
  3. 3.Louis Stokes Cleveland VA Medical CenterClevelandUSA
  4. 4.Department of Internal MedicineTenri City HospitalTenriJapan
  5. 5.Department of PulmonologyFukuoka National HospitalFukuokaJapan
  6. 6.Department of Electrical Engineering and Computer ScienceCase Western Reserve UniversityClevelandUSA

Personalised recommendations