Skip to main content
SpringerLink
Log in

Influence of continuous positive airway pressure on sleep apnea-related desaturation in sleep apnea patients

  • Published:
Lung Aims and scope Submit manuscript

Abstract

To investigate the influence of nasal continuous positive airway pressure (CPAP) on apnea-related desaturation, we compared the sleep apnea-related desaturations obtained during a poly somnographic study before and during nasal CPAP in 15 sleep apnea patients. An individual desaturation curve was determined with a regression analysis by plotting the lowest SaO2 value reached during each apnea against its duration; these data were collected throughout the night. At baseline, we only considered the apneas with a preapneic SaO2 value greater than 90% and a minimal SaO2 value above or equal to 60%. For the CPAP study, the preapneic Sa02 value also had to be within 2% the baseline value for the apneas to be retained. Due to the restriction criteria imposed to characterize apnea-related Sa02 falls, residual apneas still had to be recorded with CPAP. These data were analyzed separately for obstructive apnea for non-rapid eye movement (REM) and REM sleep stages. A desaturation curve was obtained from 10 sec to a variable upper limit that corresponded to the longest apnea duration commonly reached during both baseline and CPAP for a given apnea-type and sleep stage. The individual apnea-related Sa02 fall was characterized by measuring a desaturation area corresponding to the area under the curve. It was expressed in % Sa02/sec of apnea. CPAP reduced the number of apneas per hour of sleep from 37.5 ± 6.5 (mean ± SEM) to 14.3 ∓ 3.7 (p = 0.001), and improved the whole night SaO2, level as estimated by a cumulative SaO2 curve. The mean apnea duration was reduced from 22.9 ± 1.5 sec at baseline to 16.8 ± 0.5 sec during CPAP therapy (p = 0.005). The preapneic SaO2 value was 94.8 ± 0.3% at baseline and 95.5 ± 0.2% during CPAP (p = 0.5). The desaturation area decreased from 267 ± 48% SaO2/sec at baseline to 152 ± 41% Sa02/sec during CPAP (p < 0.001). We conclude that CPAP improves the apnea-related desaturation independently of the shortening of apneas and of any difference in the preapneic SaO2 value.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abbey NC, Cooper KR, Kwentus JA (1989) Benefit of nasal CPAP in obstructive sleep apnea is due to positive pharyngeal pressure. Sleep 12:420–422

    Google Scholar 

  2. Arronson RM, Alex CG, Onal E, Lopata M (1987) Changes in end-expiratory lung volume during sleep in patients with occlusive apnea. J Appl Physiol 63:1642–1647

    Google Scholar 

  3. Berthon Jones M, Sullivan CE (1987) Time course of change in ventilatory response to CO2 with long term CPAP therapy for obstructive sleep apnea. Am Rev Respir Dis 135: 144–147

    Google Scholar 

  4. Bradley TD, Martinez D, Rutherford R, Lue F, Grossman RF, Moldofsky H, Zamel N, Phillipson EA (1985) Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea. J Appl Physiol 59:1364–1368

    Google Scholar 

  5. Chada TS, Watson H, Birch S, Genouri GA, Schneider AW, Cohn MA, Sackner MA (1982) Validation of respiratory inductive plethysmography using different calibration procedures. Am Rev Respir Dis 125:644–649

    Google Scholar 

  6. Findley LJ, Ries AL, Tisi GM, Wagner PD (1983) Hypoxemia during apnea in normal subjects: mechanisms and impact of lung volume. J Appl Physiol 55:1777–1783

    Google Scholar 

  7. Fletcher EC, Kass R, Thornby JI, Rosborough J, Miller T (1990) Central venous O2 saturation and rate of arterial desaturation during obstructive apnea. J Appl Physiol 66:1477–1485

    Google Scholar 

  8. Fletcher EC, White SG, Munafo D, Miller CC, Luckett R, Quian W (1991) Effects of cardiac output reduction on rate of desaturation in obstructive apnea. Chest 99:452–456

    Google Scholar 

  9. Grimby G, Soderholm B (1963) Spirometric studies in normal subjects. Static lung volume and maximum voluntary ventilation in adults with a note on physical fitness. Acta Med Scand 173:199–206

    Google Scholar 

  10. Hudgel DW, Devadatta P (1984) Decrease in functional residual capacity during sleep in normal humans. J Appl Physiol 57:1319–1322

    Google Scholar 

  11. Issa FG, Sullivan CE (1986) Reversal of central sleep apnea using nasal CPAP. Chest 90:165–171

    Google Scholar 

  12. McEvoy RD, Thornton AT (1984) Treatment of obstructive sleep apnea syndrome with nasal continuous positive airway pressure. Sleep 7:313–325

    Google Scholar 

  13. Mahadevia AK, Onal E, Lopata M (1983) Effects of expiratory positive airway pressure on sleep induced respiratory abnormalities in patients with hypersomnia-sleep apnea syndrome. Am Rev Respir Dis 128:708–711

    Google Scholar 

  14. Martin RJ (Chairman) (1985) Indications and standards for cardiopulmonary sleep studies. Sleep 8:371–379

    Google Scholar 

  15. Rechtschaffen A, Kales A (eds.) (1968) A manual of standardized terminology, techniques and scoring for sleep stages of human subjects. Los Angeles, Brain information service/Brain research institute, University of California, LA

    Google Scholar 

  16. Sanders MH (1984) Nasal CPAP effect on patterns of sleep apnea. Chest 86:839–844

    Google Scholar 

  17. Sériès F, Cormier Y, La Forge J (1989) Non-apneic REM sleep induced nocturnal oxygen desaturation treated by nasal continuous positive airway pressure. Thorax 44:521–522

    Google Scholar 

  18. Sériès F, Cormier Y, La Forge J (1990) Influence of apnea-type and sleep stage on nocturnal post-apneic desaturation. Am Rev Respir Dis. 141:1522–1526

    Google Scholar 

  19. Sériès F, Cormier Y, La Forge J (1989) Role of lung volumes in sleep apnea-related oxygen desaturation. Eur Respir J 2:26–30

    Google Scholar 

  20. Sériès F, Cormier Y, Lampron N, La Forge J (1989) Influence of lung volume in sleep apnea. Thorax 4:52–57

    Google Scholar 

  21. Sforza E, Krieger J, Weitzenblum E, Apprill M, Lampert E, Ratamahoro J (1990) Long term effects of treatment with nasal continuous positive airway pressure on daytime lung function and pulmonary hemodynamics in patients with obstructive sleep apnea. Am Rev Respir Dis 141:866–870

    Google Scholar 

  22. Sullivan CE, Issa F, Berthon Jones M, Eves L (1981) Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet Ap 18:862–865

    Google Scholar 

  23. Tilkian AG, Guilleminault C, Schoeder JS, Leherman KS, Simmons B, Dement WC (1976) Hemodynamics in sleep-induced apnea. Ann Intern Med 85:714–719

    Google Scholar 

  24. Takasaki Y, Orr D, Popkin J, Rutherford R, Liu P, Bradley TD (1989) Effects of continuous positive airway pressure on sleep apnea in congestive heart failure. Am Rev Respir Dis 140:1578–1584

    Google Scholar 

  25. Tusiewickz K, Moldofsky H, Bryan AC, Bryan MH (1977) Mechanics of the rib cage and diaphragm during sleep. J Appl Physiol 43:600–602

    Google Scholar 

  26. Wilhoit SC, McTier RF, Findley L, Suratt PM (1985) Treatment of obstructive sleep apnea with continuous nasal flow. Lung 163:233–241

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unité de Recherche, Centre de Pneumologie de l'Hôpital Laval, Université Laval, 2725 Chemin Ste. Foy Ste Foy (PQ), GIV, 4135, Québec, Canada

    F. Series, Y. Cormier & J. Laforge

Authors
  1. F. Series
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y. Cormier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Laforge
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Series, F., Cormier, Y. & Laforge, J. Influence of continuous positive airway pressure on sleep apnea-related desaturation in sleep apnea patients. Lung 170, 281–290 (1992). https://doi.org/10.1007/BF00566680

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00566680

Key words

Search

Navigation