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Phenotyping OSAH patients during wakefulness

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Although currently there are simplified methods to measure the pathophysiological traits that stimulate the occurrence and maintenance of obstructive sleep apnea–hypopnea (OSAH), they remain difficult to implement in routine practice. This pilot study aimed to find a simpler daytime approach to obtain a meaningful, similar pathophysiological phenotypic profile in patients with OSAH.

Methods

After obtaining diagnostic polygraphy from a group of consecutive patients with OSAH, we performed the dial-down CPAP technique during nocturnal polysomnography and used it as reference method. This allowed assessment of upper airway collapsibility, loop gain (LG), arousal threshold (AT), and upper airway muscle gain (UAG). We compared these results with a daytime protocol based on negative expiratory pressure (NEP) technique for evaluating upper airway collapsibility and UAG, on maximal voluntary apnea for LG, and on clinical predictors for AT.

Results

Of 15 patients studied, 13 patients with OSAH accurately completed the two procedures. There were strong (all r2 > 0.75) and significant (all p < 0.001) correlations for each phenotypic trait between the measurements obtained through the reference method and those achieved during wakefulness.

Conclusion

It is possible to phenotype patients with OSAH from a pathophysiological point of view while they are awake. Using this approach, cutoff values corresponding to those usually adopted using the reference method can be identified to detect abnormal traits, achieving profiles similar to those obtained through the dial-down CPAP technique.

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Acknowledgements

The Authors acknowledge Mr. M. Guerini and Mr. L. Pedroni, University Lab. technicians, for their invaluable technical support.

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Authors and Affiliations

  1. Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy

    L. Pini, R. Magri, G. Levi, L. Zambelli, J. Giordani, M. Ciarfaglia & C. Tantucci

  2. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    L. Pini & C. Tantucci

  3. Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy

    E. Perger

  4. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    E. Perger

Authors
  1. L. Pini
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  2. R. Magri
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  3. E. Perger
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  4. G. Levi
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  5. L. Zambelli
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  6. J. Giordani
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  7. M. Ciarfaglia
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  8. C. Tantucci
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Contributions

Study design: CT and LP. Data collection: RM, GL, LZ. Data analysis: EP and LP. Interpretation of results: all authors. Initial draft: CT. Review of the manuscript for intellectual content: all authors.

Corresponding author

Correspondence to L. Pini.

Ethics declarations

Ethics approval

The study was performed in accordance with the Helsinki declaration and was approved by the University of Brescia's Department of Clinical and Experimental Science (DSCS) Ethic Committee.

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All participants signed written informed consent upon enrolling.

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All participants signed written consent for publication upon enrolling.

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The authors declare no competing interests.

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Pini, L., Magri, R., Perger, E. et al. Phenotyping OSAH patients during wakefulness. Sleep Breath 26, 1801–1807 (2022). https://doi.org/10.1007/s11325-021-02551-5

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  • DOI: https://doi.org/10.1007/s11325-021-02551-5

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