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Comparison of diaphragmatic EMG and oesophageal pressure in obstructed and unobstructed breathing during sleep

Korrelation von diaphragmalem EMG und Ösophagusdruckmessung bei obstruierter und unobstruierter Atmung im Schlaf

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Summary

Question of the study

The importance of quantitative changes in respiratory effort during routine polysomnographic investigation has been recognized since the description of the upper airway resistance syndrome. In clinical settings, oesophageal manometry is rerely conducted on a routine basis. We therefore developed a new technique for semiquantitative assessment of respiratory effort using diaphragmatic EMG (EMGdi) monitoring and tested its efficacy.

Patients and methods

Five patients with obstructive sleep apnoea syndrome and five subjects without sleep-disordered breathing were investigated in a private sleep disorders laboratory. EMGdi was sampled at 0.25 kHz and processed to a moving average. For each inspiratory effort during apnoea/hypopnoea and unobstructed breathing, we calculated maximum EMGdi and Pes. Data were normalized calculating the percentage difference between the first obstructed and each subsequent inspiratory effort during respiratory events and control periods.

Results

A total of 583 periods with unobstructed breathing and 477 apnoeas and hypopnoeas were scored to compare the evolution between Pes and EMGdi. There was a significant difference in the evolution of both respiratory parameters in unobstructed breathing versus apnoeas and hypopnoeas. EMGdi and Pes evolution corresponded in each condition investigated. In unobstructed periods, the increase of Pes averaged +2.6±24.1% versus −1.1±37.4% for EMGdi (P=0.616). In apnoeas and hypopnoeas, the respective values were +90.2±38.0% for Pes and +82.4±31.6% for EMGdi (P=0.7330).

Conclusion

EMGdi can be used in lieu of oesophageal manometry to describe relative changes in respiratory effort under conditions of normal and obstructed breathing during sleep.

Zusammenfassung

Fragestellung

Die Bedeutung quantitativer Veränderungen der Atmungsanstrengung im Schlaf ist seit der Beschreibung des “Upper Airway Resistance Syndromes” bekannt. In klinischen Schlaflaborsettings kann die Ösophagusdruckmessung (Pös) jedoch selten routinemäßig durchgeführt werden. Aus diesem Grunde haben wir eine neue Methode entwickelt, mit der sich die Atmungsanstrengung mittels diaphragmaler EMG Ableitung (EMGdi) semiquantitativ bestimmen lässt.

Patienten und Methodik

5 Patienten mit Obstruktivem Schlafapnoesyndrom und 5 Probanden ohne schlafbezogene Atmungsstörung wurden im privaten Schlaflabor untersucht. EMGdi wurde mit 0,25 kHz abgetastet und in einen gleitenden Mittelwert umgewandelt. Für jeden apnoeischen/hypopnoeischen Atmungszyklus und unter Normalatmung wurden die Pös und EMGdi Maxima berechnet. Die Daten wurden durch Berechnung der prozentualen Veränderungen über die Dauer der Apnoen/Hypopnoen und Phasen mit Normalatmung normalisiert.

Ergebnisse

583 Phasen unter Normalatmung und 477 Apnoen und Hypopnoen wurden ausgewertet, um die Veränderungen von Pös und EMGdi zu vergleichen. Signifikante Unterschiede der Veränderungen beider respiratorischer Parameter bestanden im Vergleich zwischen Normalatmung und Apnoen/Hypopnoen. Signifikante Unterschiede zwischen EMGdi und Pös wurden nicht beobachtet. In Kontrollphasen unter Normalatmung stieg Pös im Mittel um +2,6±24,1% versus −1,1±37,4% EMGdi (P=0,616) an. In Apnoen und Hypopnoen betrug der mittlere Pös Anstieg +90,2±38,0% und der mittlere EMGdi Anstieg +82,4±31,6% (P=0,7330).

Schlussfolgerung

EMGdi kann als Ersatzparameter für Pös in Schlaflabormessungen benutzt werden, um relative Veränderungen der Atmungsanstrengung unter Normalatmung und obstruierter Atmung imSchlaf zu beschreiben.

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Authors and Affiliations

  1. Zentrum für Schlafmedizin und Schlafstörungen GbR, Dortmund Sleep Disorders Centre, 44263, Dortmund, Germany

    Lennart Knaack, Hans-Christian Blum & Riccardo A. Stoohs MD

  2. Abteilungen für Hals-Nasen-Ohren Heilkunde und Interventionelle Schlafmedizin, Alfried Krupp von Bohlen und Halbach Krankenhaus, Essen, Germany

    Winfried Hohenhorst

  3. Zentrum für ambulante Schlafdiagnostik, Ludwigshafen, Germany

    Jan Ryba

  4. Sleep Disorders Clinic and Research Centre, Stanford University School of Medicine, Stanford, CA, USA

    Christian Guilleminault & Riccardo A. Stoohs MD

Authors
  1. Lennart Knaack
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  2. Hans-Christian Blum
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  3. Winfried Hohenhorst
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  4. Jan Ryba
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  5. Christian Guilleminault
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  6. Riccardo A. Stoohs MD
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Corresponding author

Correspondence to Riccardo A. Stoohs MD.

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Knaack, L., Blum, HC., Hohenhorst, W. et al. Comparison of diaphragmatic EMG and oesophageal pressure in obstructed and unobstructed breathing during sleep. Somnologie 9, 159–165 (2005). https://doi.org/10.1111/j.1439-054X.2005.00059.x

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  • DOI: https://doi.org/10.1111/j.1439-054X.2005.00059.x

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