Objective: Obstructive sleep apnea-hypopnea syndrome (OSA) is a disease of obstructive apnea or hypopnea caused by a repeated partial or complete collapse of the upper airway during sleep. The inspiratory part of the flow-volume curve (F-V curve) can be used as an auxiliary means to evaluate upper airway obstruction in adults. This study is to evaluate the ability of the F-V curve to predict the OSA and explore inspiratory indicators related to airway obstruction during sleep. Methods: There were 332 patients included in this cross-sectional study, who were accompanied by snoring, daytime sleepiness and other symptoms, with suspicion of OSA. According to the nocturnal polysomnography, the subjects were distributed into mild to moderate OSA group, severe OSA group and non-OSA group. A pulmonary function test was used to collect the subjects’ spirometry and F-V curves. Results: There was no significant difference in a variety of indices derived from the F-V curve between OSA and normal subjects, including 25% inspiratory flow rate, middle inspiratory flow rate, 75% inspiratory flow rate, peak flow rate, and forced inspiratory flow rate in the first second. The pulmonary function parameters were significantly correlated with the weight, age and sex of the subjects. Conclusion: These findings suggest that the inspiratory curve of pulmonary function cannot evaluate the upper airway abnormalities in patients with obstructive apnea-hypopnea syndrome.
References
[1]
Kapur, V.K., Auckley, D.H., Chowdhuri, S., Kuhlmann, D.C., Mehra, R., Ramar, K. and Harrod, C.G. (2017) Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13, 479-504. https://doi.org/10.5664/jcsm.6506
[2]
Sateia, M.J. (2014) International Classification of Sleep Disorders. Third Edition: Highlights and Modifications. Chest, 146, 1387-1394. https://doi.org/10.1378/chest.14-0970
[3]
Aishah, A. and Eckert, D.J. (2019) Phenotypic Approach to Pharmacotherapy in the Management of Obstructive Sleep Apnoea. Current Opinion in Pulmonary Medicine, 25, 594-601. https://doi.org/10.1097/MCP.0000000000000628
[4]
Whyte, A. and Gibson, D. (2020) Adult Obstructive Sleep Apnoea: Pathogenesis, Importance, Diagnosis and Imaging. Journal of Medical Imaging and Radiation Oncology, 64, 52-66. https://doi.org/10.1111/1754-9485.12978
[5]
Suga, H., Iwasaki, T., Mishima, K., Nakano, H., Ueyama, Y. and Yamasaki, Y. (2021) Evaluation of the Effect of Oral Appliance Treatment on Upper-Airway Ventilation Conditions in Obstructive Sleep Apnea Using Computational Fluid Dynamics. Cranio, 39, 209-217. https://doi.org/10.1080/08869634.2019.1596554
[6]
Eckert, D.J. (2018) Phenotypic Approaches to Obstructive Sleep Apnoea—New Pathways for Targeted Therapy. Sleep Medicine Reviews, 37, 45-59. https://doi.org/10.1016/j.smrv.2016.12.003
[7]
Togeiro, S.M., Chaves, C.M., Palombini, L., Tufik, S., Hora, F. and Nery, L.E. (2010) Evaluation of the Upper Airway in Obstructive Sleep Apnoea. Indian Journal of Medical Research, 131, 230-235.
[8]
Graham, B.L., Steenbruggen, I., Miller, M.R., Barjaktarevic, I.Z., Cooper, B.G., Hall, G.L., Hallstrand, T.S., Kaminsky, D.A., McCarthy, K., McCormack, M.C., et al. (2019) Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. American Journal of Respiratory and Critical Care Medicine, 200, e70-e88. https://doi.org/10.1164/rccm.201908-1590ST
[9]
Culver, B.H., Graham, B.L., Coates, A.L., Wanger, J., Berry, C.E., Clarke, P.K., et al. (2017) Recommendations for a Standardized Pulmonary Function Report. An Official American Thoracic Society Technical Statement. American Journal of Respiratory and Critical Care Medicine, 196, 1463-1472. https://doi.org/10.1164/rccm.201710-1981ST
[10]
Townsend, M.C. (2020) The American Thoracic Society/European Respiratory Society 2019 Spirometry Statement and Occupational Spirometry Testing in the United States. American Journal of Respiratory and Critical Care Medicine, 201, 1010-1011. https://doi.org/10.1164/rccm.201911-2267LE
[11]
Eber, E. (2004) Evaluation of the Upper Airway. Paediatric Respiratory Reviews, 5, 9-16. https://doi.org/10.1016/j.prrv.2003.09.006
[12]
Kraft, S.M., Sykes, K., Palmer, A. and Schindler, J. (2015) Using Pulmonary Function Data to Assess Outcomes in the Endoscopic Management of Subglottic Stenosis. Annals of Otology, Rhinology & Laryngology, 124, 137-142. https://doi.org/10.1177/0003489414548915
[13]
Shim, C., Corro, P., Park, S.S. and Williams, M.H. (1972) Pulmonary Function Studies in Patients with Upper Airway Obstruction. American Review of Respiratory Disease, 106, 233-238. https://doi.org/10.1164/arrd.1972.106.2.233
[14]
Berry, R.B., Budhiraja, R., Gottlieb, D.J., Gozal, D., Iber, C., Kapur, V.K., et al. (2012) Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 8, 597-619. https://doi.org/10.5664/jcsm.2172
[15]
Zhang, J., Hu, X. and Shan, G. (2017) Spirometry Reference Values for Population Aged 7-80 Years in China. Respirology, 22, 1630-1636. https://doi.org/10.1111/resp.13118
[16]
Oliven, R., Cohen, G., Somri, M., Schwartz, A.R. and Oliven, A. (2019) Peri-Pharyngeal Muscle Response to Inspiratory Loading: Comparison of Patients with OSA and Healthy Subjects. Journal of Sleep Research, 28, e12756. https://doi.org/10.1111/jsr.12756
[17]
Raposo, L.B., Bugalho, A. and Gomes, M.J. (2013) Contribution of Flow-Volume Curves to the Detection of Central Airway Obstruction. Jornal Brasileiro de Pneumologia, 39, 447-454. https://doi.org/10.1590/S1806-37132013000400008
[18]
Campbell, A.H., Guy, P.A., Rochford, P.D., Worsnop, C.J. and Pierce, R.J. (2000) Flow-Volume Curve Changes in Patients with Obstructive Sleep Apnoea and Brief Upper Airway Dysfunction. Respirology, 5, 11-18. https://doi.org/10.1046/j.1440-1843.2000.00220.x
[19]
Sata, N., Inoshita, A., Suda, S., Shiota, S., Shiroshita, N., Kawana, F., et al. (2021) Clinical, Polysomnographic, and Cephalometric Features of Obstructive Sleep Apnea with AHI over 100. Sleep Breath, 25, 1379-1387. https://doi.org/10.1007/s11325-020-02241-8
[20]
Ernst, G., Bosio, M., Salvado, A., Dibur, E., Nigro, C. and Borsini, E. (2016) Difference between Apnea-Hypopnea Index (AHI) and Oxygen Desaturation Index (ODI): Proportional Increase Associated with Degree of Obesity. Sleep Breath, 20, 1175-1183. https://doi.org/10.1007/s11325-016-1330-3
[21]
Masa, J.F., Pépin, J.L., Borel, J.C., Mokhlesi, B., Murphy, P.B. and Sánchez-Quiroga, M. (2019) Obesity Hypoventilation Syndrome. European Respiratory Review, 28, Article ID: 180097. https://doi.org/10.1183/16000617.0097-2018
[22]
Littleton, S.W. and Tulaimat, A. (2017) The Effects of Obesity on Lung Volumes and Oxygenation. Respiratory Medicine, 124, 15-20. https://doi.org/10.1016/j.rmed.2017.01.004
[23]
Suzuki, M., Funayama, Y., Homma, M., Shibasaki, K., Furukawa, T. and Yosizawa, T. (2021) Effect of Position Therapy and Oral Devices on Sleep Parameters in Patients with Obstructive Sleep Apnea. European Archives of Oto-Rhino-Laryngology, 278, 4545-4550. https://doi.org/10.1007/s00405-021-06817-2
[24]
Rissanen, M., Oksenberg, A., Töyräs, J., Myllymaa, S. and Leppänen, T. (2021) Total Durations of Respiratory Events Are Modulated within REM and NREM Sleep by Sleeping Position and Obesity in OSA Patients. Sleep Medicine, 81, 394-400. https://doi.org/10.1016/j.sleep.2021.02.020
[25]
Osman, A.M., Carter, S.G., Carberry, J.C. and Eckert, D.J. (2018) Obstructive Sleep Apnea: Current Perspectives. Nature and Science of Sleep, 10, 21-34. https://doi.org/10.2147/NSS.S124657
[26]
Osman, A.M., Carberry, J.C., Gandevia, S.C., Butler, J.E. and Eckert, D.J. (2020) Changes in Pharyngeal Collapsibility and Genioglossus Reflex Responses to Negative Pressure during the Respiratory Cycle in Obstructive Sleep Apnoea. The Journal of Physiology, 598, 567-580. https://doi.org/10.1113/JP278433
[27]
Oliven, R., Cohen, G., Somri, M., Schwartz, A.R. and Oliven, A. (2020) Relationship between the Activity of the Genioglossus, Other Peri-Pharyngeal Muscles and Flow Mechanics during Wakefulness and Sleep in Patients with OSA and Healthy Subjects. Respiratory Physiology & Neurobiology, 274, Article ID: 103362. https://doi.org/10.1016/j.resp.2019.103362
[28]
Oliven, R., Cohen, G., Somri, M., Schwartz, A.R. and Oliven, A. (2019) Spectral Analysis of Peri-Pharyngeal Muscles’ EMG in Patients with OSA and Healthy Subjects. Respiratory Physiology & Neurobiology, 260, 53-57. https://doi.org/10.1016/j.resp.2018.12.002
