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Influence of interface and position on upper airway collapsibility assessed by negative expiratory pressure

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Negative expiratory pressure (NEP) is a simple technique for the evaluation of upper airway collapsibility in patients with obstructive sleep apnea (OSA). Most studies evaluated NEP using a mouthpiece that may exclude the cephalic portion of the upper airway. We hypothesize that NEP determination is influenced by interface and position.

Methods

We evaluated patients with suspected OSA using polysomnography, NEP (−5 cmH2O in sitting and supine position with mouthpiece and nasal mask). A subgroup also underwent computed tomography (CT) of the upper airway.

Results

We studied a total of 86 subjects (72 male, age 46 ± 12 yrs, body mass index 30.0 ± 4.4 kg/m2, neck circumference 40.0 ± 3.5 cm, AHI 32.9 ± 26.4, range 0.5 to 122.5 events/hour). NEP was influenced by interface and position (p = 0.007), and upper airway was more collapsible with mouthpiece than with nasal mask in sitting position (p = 0.001). Position influenced NEP and was worse in supine only when evaluated by nasal mask. Expiratory resistance (R 0.2) at 0.2 s during NEP was significantly higher and independent of position with mouthpiece than with nasal mask (20.7 versus 8.6 cmH2O/L s−1, respectively, p = 0.018). NEP evaluated with nasal mask in supine position and with mouthpiece in sitting position, but not when evaluated with mouthpiece in supine position, were correlated with upper airway anatomical measurements including tongue dimensions and pharyngeal length.

Conclusions

Interface and position influence NEP. NEP evaluated with nasal mask in supine position may convey more relevant information for patients under investigation for OSA than when evaluated with mouthpiece.

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Acknowledgments

Author contributions

RPH contributed to the study design, data collection, and analysis and interpretation of the data and manuscript draft; FK, FS, and EG contributed to the data collection and analysis, and critical review of the manuscript; HTM contributed to the data analysis and interpretation and critical review of the manuscript; PRG contributed to the study design, data analysis and interpretation, and critical review of the manuscript; SR, GI, and LVFO contributed to the data collection and analysis and critical review of the manuscript; and GLF contributed to the study design, data analysis and interpretation, drafting, and critical review of the manuscript.

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Authors and Affiliations

  1. Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Doutor Eneas de Carvalho Aguiar, 44, 8° Andar, Bloco I, CEP, São Paulo, SP, 05403-900, Brazil

    Raquel Pastrello Hirata, Fabiane Kayamori, Fabiola Schorr, Pedro Rodrigues Genta & Geraldo Lorenzi-Filho

  2. Biomedical Engineering Laboratory, Escola Politécnica, Universidade de São Paulo, São Paulo, Brazil

    Henrique Takachi Moriya

  3. Italian National Research Council, Institute of Biomedicine and Molecular Immunology A. Monroy, Palermo, Italy

    Salvatore Romano & Giuseppe Insalaco

  4. Radiology Institute (InRad), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Eloisa Gebrim

  5. Rehabilitation Sciences Master and Doctoral Program, Universidade Nove de Julho, São Paulo, Brazil

    Luis Vicente Franco de Oliveira

Authors
  1. Raquel Pastrello Hirata
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  2. Fabiane Kayamori
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  3. Fabiola Schorr
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  4. Henrique Takachi Moriya
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  5. Salvatore Romano
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  6. Giuseppe Insalaco
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  7. Eloisa Gebrim
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  8. Luis Vicente Franco de Oliveira
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  9. Pedro Rodrigues Genta
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  10. Geraldo Lorenzi-Filho
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Corresponding author

Correspondence to Geraldo Lorenzi-Filho.

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Funding

Sao Paulo Research Foundation (FAPESP) provided financial support in the form of the grant numbers: 2012/20743-5 and 2011/12120-5. The sponsor had no role in the design or conduct of this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Guarantor statement

RPH had full access to all of the data and takes responsibility for the integrity of the work as a whole, from inception to published article.

Financial/nonfinancial disclosures

All the authors have reported that there are no conflicts of interest with any companies or organizations discussed in this article.

Role of sponsors

This study was supported by São Paulo Research Foundation (FAPESP), grant number 2011/12120-5. RPH received a PhD scholarship from FAPESP, grant number 2012/20743-5.

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Hirata, R.P., Kayamori, F., Schorr, F. et al. Influence of interface and position on upper airway collapsibility assessed by negative expiratory pressure. Sleep Breath 21, 631–638 (2017). https://doi.org/10.1007/s11325-016-1445-6

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  • DOI: https://doi.org/10.1007/s11325-016-1445-6

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