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End-expiratory lung volume decreases during REM sleep despite continuous positive airway pressure

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Patients with obstructive sleep apnea (OSA) may experience apneas and hypopneas primarily during stage R (REM) sleep when end-expiratory lung volume (EELV) reaches its nadir. The purpose of this study was to determine if REM-related reductions in EELV persist in the presence of continuous positive airway pressure (CPAP) prescribed during non-stage REM (NREM) sleep.

Methods

We prospectively recruited 17 subjects referred to the sleep laboratory for CPAP titration. CPAP was titrated per AASM protocol to control respiratory events. The change in EELV was measured using magnetometry.

Results

Of the 17 subjects, 12 (71%) had moderate to severe OSA. Despite the application of CPAP, there was a significant reduction in EELV between NREM and REM sleep (− 105.9 ± 92.2 to − 325.0 ± 113.1 mL, respectively, p < 0.01). The change in EELV between non-stage R (NREM) and REM significantly correlated with overall apnea-hypopnea index (AHI) (r = 0.5, p = 0.04), the number of respiratory arousals during REM (r = 0.5, p = 0.04), and prescribed level of CPAP (r = 0.7, p < 0.01).

Conclusion

REM-related reductions in EELV are associated with worsening sleep disordered breathing and occur despite the presence of CPAP.

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Abbreviations

AASM:

American Academy of Sleep Medicine

Ab:

Abdomen

AHI:

Apnea-hypopnea index

auto CPAP:

An automatic titrating CPAP device

BMI:

Body mass index

CPAP:

Continuous positive airway

ΔEELV:

Change in end-expiratory lung volume

EELV:

End-expiratory lung volume

FRC:

Functional residual capacity

NREM:

Non-stage R sleep

OSA:

Obstructive sleep apnea

Pcrit:

Pharyngeal critical pressure

PSG:

Polysomnography

RC:

Rib cage

REM:

Stage R/rapid eye movement sleep

SDB:

Sleep-disordered breathing

Stage R:

REM sleep

VT:

Tidal volume

Xi:

Axial displacement

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Authors and Affiliations

  1. Baroness Erlanger Hospital, Respiratory, Critical Care, and Sleep Medicine, University of Tennessee College of Medicine Chattanooga, 975 E 3rd Street, C-735, Chattanooga, TN, 37403, USA

    Patrick Koo & Jigme M. Sethi

  2. Providence VA Medical Center, Alpert Medical School of Brown University, Providence, RI, USA

    Eric J. Gartman

  3. Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA

    F. Dennis McCool

Authors
  1. Patrick Koo
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  2. Eric J. Gartman
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  3. Jigme M. Sethi
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  4. F. Dennis McCool
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Corresponding author

Correspondence to Patrick Koo.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

All authors have seen and approved the manuscript.

Work for this study was performed at Alpert Medical School of Brown University, Memorial Hospital of Rhode Island.

Conflict of interest

The authors declare that they have no conflict of interests.

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Koo, P., Gartman, E.J., Sethi, J.M. et al. End-expiratory lung volume decreases during REM sleep despite continuous positive airway pressure. Sleep Breath 24, 119–125 (2020). https://doi.org/10.1007/s11325-019-01857-9

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  • DOI: https://doi.org/10.1007/s11325-019-01857-9

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