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Upper Airway Neurostimulation to Treat Obstructive Sleep Apnea. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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52
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Abstract
RATIONALE Owing to resource limitations, the testing of patients for obstructive sleep apnea (OSA) is often delayed. There is a need to accurately triage and expedite testing in those with a high pretest probability of OSA. Acoustic pharyngometry is a simple, noninvasive technique used to assess the upper airway cross-sectional area (UA-XSA), which is known to be reduced in those with OSA. OBJECTIVES To determine the discriminative ability and predictive value of UA-XSA measurements by acoustic pharyngometry for OSA. METHODS We conducted a cross-sectional study with a clinical cohort of consecutive adults with suspected OSA who had undergone both polysomnography and acoustic pharyngometry. OSA was defined as an apnea-hypopnea index greater than or equal to 5. Multivariable logistic regression analyses and receiver operating characteristic curves were used. MEASUREMENTS AND MAIN RESULTS The cohort included 576 subjects, 87% of whom had OSA and 64% of whom were men. The subjects' median body mass index (BMI) was 30.3 kg/m2, and their median age was 57 years. The median UA-XSA at FRC when sitting was significantly smaller in those with OSA compared with those without OSA (3.3 cm2 [interquartile range, 2.7-3.8] vs. 3.7 cm2 [interquartile range, of 2.9-4.2]). When the analysis was controlled for age, sex, BMI, and comorbidities, the odds of OSA increased for every 1-cm2 decrease in the mean UA-XSA FRC when sitting (odds ratio, 1.62; 95% confidence interval, 1.23-2.13). The mean UA-XSA provided fair discrimination for OSA (area under the curve, 0.60). A cutoff value of 3.75 cm2, the point with the best sum of sensitivity and specificity, had sensitivity of 73% and specificity of 46%. The magnitude of the incremental discriminative value of UA-XSA over clinical variables (age, sex, BMI, and comorbidities) was small and nonsignificant (P = 0.5). CONCLUSIONS The mean UA-XSA at FRC when sitting or supine provided no further significant advantage over clinical variables for the discernment of OSA.
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Kendall MC, Robbins ZM, Cohen A, Minn M, Benzuly SE, Triebwasser AS, McCormick ZL, Gorgone M. Selected highlights in clinical anesthesia research. J Clin Anesth 2017; 43:90-97. [DOI: 10.1016/j.jclinane.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 12/17/2022]
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Balakrishnan S, Bu R, Price H, Zdanski C, Oldenburg AL. Multi-modal anatomical Optical Coherence Tomography and CT for in vivo Dynamic Upper Airway Imaging. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10039. [PMID: 29056811 DOI: 10.1117/12.2250348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We describe a novel, multi-modal imaging protocol for validating quantitative dynamic airway imaging performed using anatomical Optical Coherence Tomography (aOCT). The aOCT system consists of a catheter-based aOCT probe that is deployed via a bronchoscope, while a programmable ventilator is used to control airway pressure. This setup is employed on the bed of a Siemens Biograph CT system capable of performing respiratory-gated acquisitions. In this arrangement the position of the aOCT catheter may be visualized with CT to aid in co-registration. Utilizing this setup we investigate multiple respiratory pressure parameters with aOCT, and respiratory-gated CT, on both ex vivo porcine trachea and live, anesthetized pigs. This acquisition protocol has enabled real-time measurement of airway deformation with simultaneous measurement of pressure under physiologically relevant static and dynamic conditions- inspiratory peak or peak positive airway pressures of 10-40 cm H2O, and 20-30 breaths per minute for dynamic studies. We subsequently compare the airway cross sectional areas (CSA) obtained from aOCT and CT, including the change in CSA at different stages of the breathing cycle for dynamic studies, and the CSA at different peak positive airway pressures for static studies. This approach has allowed us to improve our acquisition methodology and to validate aOCT measurements of the dynamic airway for the first time. We believe that this protocol will prove invaluable for aOCT system development and greatly facilitate translation of OCT systems for airway imaging into the clinical setting.
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Affiliation(s)
- Santosh Balakrishnan
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill
| | - Ruofei Bu
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill
| | - Hillel Price
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill
| | - Carlton Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Amy L Oldenburg
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill.,Department of Physics and Astronomy, University of North Carolina at Chapel Hill.,Biomedical Research Imaging Center, University of North Carolina at Chapel Hill
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Strohl MM, Yamauchi M, Peng Z, Strohl KP. Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2017; 3:133-141. [PMID: 29276665 DOI: 10.1007/s40675-017-0088-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose The literature on hypoglossal nerve stimulation (HNS) for the treatment of moderate-to-severe obstructive sleep apnea (OSA) was reviewed from 2014, the time of FDA approval for the Inspire Systems device, to 2017 for themes that might be useful conceptually and practically in the consideration of this new non-anatomic surgical therapy. Recent Findings there are now further follow-up articles since the 12-month results for Apnea Reduction (STAR) trial of the Inspire device, and post-approval publications which report similar and/0r improved AHI outcomes. Other emerging themes include drug-induced sedation endoscopy (DISE) as a tool in assessment of eligibility and a more detailed understanding of mechanisms for an HNS effects. Summary The post-STAR literature provides guidelines for an integrated coordination of medicine and surgery to appropriately screen and manage patients.
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Affiliation(s)
- Madeleine M Strohl
- Department of Otolaryngology, University of California, San Francisco, San Francisco CA
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Zhe Peng
- Department of Surgery, People's Hospital, Peking University, Beijing, China
| | - Kingman P Strohl
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Case School of Medicine, Cleveland OH
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Bu R, Balakrishnan S, Iftimia N, Price H, Zdanski C, Oldenburg AL. Airway compliance measured by anatomic optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2017; 8:2195-2209. [PMID: 28736665 PMCID: PMC5516819 DOI: 10.1364/boe.8.002195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/16/2017] [Accepted: 03/10/2017] [Indexed: 05/25/2023]
Abstract
Quantification of airway compliance can aid in the diagnosis and treatment of obstructive airway disorders by detecting regions vulnerable to collapse. Here we evaluate the ability of a swept-source anatomic optical coherence tomography (SSaOCT) system to quantify airway cross-sectional compliance (CC) by measuring changes in the luminal cross-sectional area (CSA) under physiologically relevant pressures of 10-40 cmH2O. The accuracy and precision of CC measurements are determined using simulations of non-uniform rotation distortion (NURD) endemic to endoscopic scanning, and experiments performed in a simplified tube phantom and ex vivo porcine tracheas. NURD simulations show that CC measurements are typically more accurate than that of the CSAs from which they are derived. Phantom measurements of CSA versus pressure exhibit high linearity (R2>0.99), validating the dynamic range of the SSaOCT system. Tracheas also exhibited high linearity (R2 = 0.98) suggestive of linear elasticity, while CC measurements were obtained with typically ± 12% standard error.
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Affiliation(s)
- Ruofei Bu
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3216, USA
| | - Santosh Balakrishnan
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3216, USA
| | - Nicusor Iftimia
- Physical Sciences Inc., New England Business Center, Andover, MA 01810, USA
| | - Hillel Price
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255, USA
| | - Carlton Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7070, USA
| | - Amy L. Oldenburg
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3216, USA
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3255, USA
- Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Nikander K, von Hollen D, Larhrib H. The size and behavior of the human upper airway during inhalation of aerosols. Expert Opin Drug Deliv 2016; 14:621-630. [PMID: 27547842 DOI: 10.1080/17425247.2016.1227780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The mouth, the pharynx and the larynx are potential sites of aerosol deposition in the upper airway during inhalation of aerosolized drugs. The right angle bend of the lumen at the back of the mouth, the position of the tongue, the variable size and shape of the lumen in the pharynx and the larynx, and the breathing pattern could increase aerosol deposition in the upper airway and decrease lung deposition. Areas covered: In this review, the anatomy of the upper airway from the oral cavity to the glottis and the impact of mandibular protrusion and incisal opening on the size of the upper airway are highlighted. In addition, the impact of inhalation maneuvers, inhaler mouthpiece geometries and a stepped mouthpiece on the size of the upper airway are discussed. Expert opinion: The structure of the upper airway lumen does not have a fixed cross sectional area and is susceptible to both constriction and distension during inhalation. The size of the upper airway can be enlarged through mandibular protrusion and/or incisal opening which might decrease aerosol deposition in the upper airway and increase lung deposition.
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Affiliation(s)
| | - Dirk von Hollen
- b Respironics Inc., a Philips Healthcare Company , Murrysville , PA , USA
| | - Hassan Larhrib
- c Department of Pharmacy and Pharmaceutical Sciences , University of Huddersfield , Huddersfield , UK
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58
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Affiliation(s)
- Patrick J Strollo
- Deaprtment of Medicine and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Atul Malhotra
- Deaprtment of Medicine, University of California San Diego, San Diego, USA
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Anandarajah S, Dudhia R, Sandham A, Sonnesen L. Risk factors for small pharyngeal airway dimensions in preorthodontic children: A three-dimensional study. Angle Orthod 2016; 87:138-146. [PMID: 27304232 DOI: 10.2319/012616-71.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze which parameters, gathered from standard orthodontic diagnostic material, were most relevant for identifying small pharyngeal airway dimensions in preorthodontic children. MATERIALS AND METHODS The sample was composed of 105 cone beam computed tomography scans of healthy preorthodontic children (44 boys, 61 girls; mean age, 10.7 ± 2.4 years). Airway volume and minimal cross-sectional area were three-dimensionally assessed. Cephalometric features and skeletal maturity were assessed on generated two-dimensional cephalograms. Associations were analyzed and adjusted for age, gender, and skeletal maturity by multiple regression analyses. RESULTS Airway volume and minimal cross-sectional area were significantly smaller in prepubertal children (P < .001, P < .05, respectively) and positively associated with age (P < .001, P < .01, respectively). After adjustment of age, skeletal maturity and gender significant associations were found between pharyngeal airway dimensions and craniofacial morphology. Airway volume was positively associated with maxillary and mandibular width (P < .01; P < .001, respectively) and anterior face height (P < .05; P < .05, respectively). Minimal cross-sectional area was positively associated with maxillary and mandibular width (P < .01; P < .001, respectively) and negatively associated with sagittal jaw relationship (AnPg, P < .05). Mandibular width and age were the most relevant factors for airway volume (r2 = 0.36). Mandibular width and sagittal jaw relationship were the most relevant factors for minimal cross-sectional area (r2 = 0.16). CONCLUSION Pharyngeal airway dimensions were significantly associated with age, skeletal maturity, and craniofacial morphology in all three planes. Children with a reduced mandibular width and increased sagittal jaw relationship are particularly at risk of having small pharyngeal airway dimensions.
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Khan MA. Dynamics of airway response in lung microsections: a tool for studying airway-extra cellular matrix interactions. J Biomed Sci 2016; 23:43. [PMID: 27176036 PMCID: PMC4865010 DOI: 10.1186/s12929-016-0263-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/06/2016] [Indexed: 01/27/2023] Open
Abstract
The biological configuration of extracellular matrix (ECM) plays a key role in how mechanical interactions of the airway with its parenchymal attachments affect the dynamics of airway responses in different pulmonary disorders including asthma, emphysema and chronic bronchitis. It is now recognized that mechanical interactions between airway tissue and ECM play a key regulatory role on airway physiology and kinetics that can lead to the reorganization and remodeling of airway connective tissue. A connective tissue is composed of airway smooth muscle cells (ASM) and the ECM, which includes variety of glycoproteins and therefore the extent of interactions between ECM and ASM affects airway dynamics during exacerbations of major pulmonary disorders. Measurement of the velocity and magnitude of airway closure or opening provide important insights into the functions of the airway contractile apparatus and the interactions with its surrounding connective tissues. This review highlights suitability of lung microsection technique in studying measurements of airway dynamics (narrowing/opening) and associated structural distortions in airway compartments.
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Affiliation(s)
- Mohammad Afzal Khan
- Department of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, MBC 03, P.O. Box 3354, Riyadh, 11211, Kingdom of Saudi Arabiana.
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61
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Zhao J, Gregersen H. Esophageal morphometric and biomechanical changes during aging in rats. Neurogastroenterol Motil 2015; 27:1638-47. [PMID: 26303784 DOI: 10.1111/nmo.12661] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/30/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Human studies have demonstrated aging-related changes in esophagus which may contribute to the increased rate of gastro-esophageal reflux in elderly. The aim of this study was to investigate esophageal morphometric and biomechanical remodeling in aging rats to obtain detailed information about aging-related changes. METHODS Twenty-four male Wistar rats, aged from 6 to 22 months, were studied. Morphometric data were obtained by measuring the wall thickness and cross-sectional area. The esophageal diameter and length were obtained from digitized images of the segments at preselected luminal pressure levels and at no-load and zero-stress states. Circumferential and longitudinal stresses (force per area) and strains (deformation) were computed from the length, diameter and pressure data, and from the zero-stress state geometry. KEY RESULTS The esophageal parameters such as the weight per unit length, the wall thickness and the wall cross-sectional area increased slightly from 6 to 22 months (p < 0.05 to p < 0.001). The opening angle gradually decreased during aging (p < 0.05). The interface between the mucosa-submucosa and muscle layers slightly moved outwards and the neutral axis moved inwards during aging. The stress-strain data showed that the esophageal wall became stiffer circumferentially and longitudinally during aging (p < 0.05, p < 0.01). However, the circumferential wall stiffness showed no further change after 12 months. CONCLUSIONS & INFERENCES A pronounced morphometric and biomechanical remodeling occurred in the rat esophagus during aging.
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Affiliation(s)
- J Zhao
- Giome Academia, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College of Chongqing University, Chongqing, China
| | - H Gregersen
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College of Chongqing University, Chongqing, China
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62
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Abdeyrim A, Zhang Y, Li N, Zhao M, Wang Y, Yao X, Keyoumu Y, Yin T. Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals. BMC Pulm Med 2015; 15:76. [PMID: 26209328 PMCID: PMC4513967 DOI: 10.1186/s12890-015-0063-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/23/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Even through narrowing of the upper-airway plays an important role in the generation of obstructive sleep apnea (OSA), the peripheral airways is implicated in pre-obese and obese OSA patients, as a result of decreased lung volume and increased lung elastic recoil pressure, which, in turn, may aggravate upper-airway collapsibility. METHODS A total of 263 male (n = 193) and female (n = 70) subjects who were obese to various degrees without a history of lung diseases and an expiratory flow limitation, but troubled with snoring or suspicion of OSA were included in this cross-sectional study. According to nocturnal-polysomnography the subjects were distributed into OSA and non-OSA groups, and were further sub-grouped by gender because of differences between males and females, in term of, lung volume size, airway resistance, and the prevalence of OSA among genders. Lung volume and respiratory mechanical properties at different-frequencies were evaluated by plethysmograph and an impulse oscillation system, respectively. RESULTS Functional residual capacity (FRC) and expiratory reserve volume were significantly decreased in the OSA group compared to the non-OSA group among males and females. As weight and BMI in males in the OSA group were greater than in the non-OSA group (90 ± 14.8 kg vs. 82 ± 10.4 kg, p < 0.001; 30.5 ± 4.2 kg/m(2) vs. 28.0 ± 3.0 kg/m(2), p < 0.001), multiple regression analysis was required to adjust for BMI or weight and demonstrated that these lung volumes decreases were independent from BMI and associated with the severity of OSA. This result was further confirmed by the female cohort. Significant increases in total respiratory resistance and decreases in respiratory conductance (Grs) were observed with increasing severity of OSA, as defined by the apnea-hypopnea index (AHI) in both genders. The specific Grs (sGrs) stayed relatively constant between the two groups in woman, and there was only a weak association between AHI and sGrs among man. Multiple-stepwise-regression showed that reactance at 5 Hz was highly correlated with AHI in males and females or hypopnea index in females, independently-highly correlated with peripheral-airway resistance and significantly associated with decreasing FRC. CONCLUSIONS Total respiratory resistance and peripheral airway resistance significantly increase, and its inverse Grs decrease, in obese patients with OSA in comparison with those without OSA, and are independently associated with OSA severity. These results might be attributed to the abnormally increased lung elasticity recoil pressure on exhalation, due to increase in lung elasticity and decreased lung volume in obese OSA.
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Affiliation(s)
- Arikin Abdeyrim
- Postgraduate college of Xinjiang Medical University, Urumqi, China.
- The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China.
| | - Yongping Zhang
- Postgraduate college of Xinjiang Medical University, Urumqi, China.
- The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China.
| | - Nanfang Li
- Postgraduate college of Xinjiang Medical University, Urumqi, China.
- The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China.
| | - Minghua Zhao
- Department of Pulmonary function test, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Yinchun Wang
- Laboratory of sleep study, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Xiaoguang Yao
- The Center of Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Youledusi Keyoumu
- Department of Otorhinolaryngology Head and Neck Surgery, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Ting Yin
- Laboratory of sleep study, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
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63
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What can impulse oscillometry and pulmonary function testing tell us about obstructive sleep apnea: a case-control observational study? Sleep Breath 2015; 20:61-8. [DOI: 10.1007/s11325-015-1185-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 04/10/2015] [Accepted: 04/14/2015] [Indexed: 11/25/2022]
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Orr JE, Edwards BA, Malhotra A. CrossTalk opposing view: Loop gain is not a consequence of obstructive sleep apnoea. J Physiol 2015; 592:2903-5. [PMID: 25027957 DOI: 10.1113/jphysiol.2014.271841] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- J E Orr
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA, USA
| | - B A Edwards
- Division of Sleep Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - A Malhotra
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA, USA Division of Sleep Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA
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Abstract
Both obstructive sleep apnea (OSA) and type 2 diabetes mellitus are commonly seen in older adults. Over the last decade, there has been increasing recognition that OSA is highly prevalent in persons with type 2 diabetes and related metabolic conditions such as insulin resistance and glucose intolerance. Intermittent hypoxemia and recurrent arousals in OSA trigger a repertoire of pathophysiological events, which can in turn alter glucose homeostasis and possibly increase the risk for type 2 diabetes. Conversely, there is evidence that type 2 diabetes may alter the progression and expression of sleep-disordered breathing.
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Affiliation(s)
- Karoline Moon
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - R Nisha Aurora
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
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66
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Kirkness JP, Sowho M, Murano E. The interplay between tongue tissue volume, hyoid position, and airway patency. Sleep 2014; 37:1585-6. [PMID: 25197803 DOI: 10.5665/sleep.4060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 12/23/2022] Open
Affiliation(s)
- Jason P Kirkness
- Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mudiaga Sowho
- Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Emi Murano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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67
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Enhanced non-eupneic breathing following hypoxic, hypercapnic or hypoxic-hypercapnic gas challenges in conscious mice. Respir Physiol Neurobiol 2014; 204:147-59. [PMID: 25242462 DOI: 10.1016/j.resp.2014.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 01/26/2023]
Abstract
C57BL6 mice display non-eupneic breathing and spontaneous apneas during wakefulness and sleep as well as markedly disordered breathing following cessation of a hypoxic challenge. We examined whether (1) C57BL6 mice display marked non-eupneic breathing following hypercapnic or hypoxic-hypercapnic challenges, and (2) compared the post-hypoxia changes in non-eupneic breathing of C57BL6 mice to those of B6AF1 (57BL6 dam × A/J sire) and Swiss-Webster mice, which display different ventilatory responses than C57BL6 mice. C57BL6 mice displayed marked increases in respiratory frequency and non-eupneic breathing upon return to room-air after hypoxic (10% O2, 90% N2), hypercapnic (5% CO2, 21% O2 and 74% N2) and hypoxic-hypercapnic (10% O2, 5% CO2 and 85% N2) challenges. B6AF1 mice displayed less tachypnea and reduced non-eupneic breathing post-hypoxia, whereas Swiss-Webster mice displayed robust tachypnea with minimal increases in non-eupneic breathing post-hypoxia. These studies demonstrate that non-eupneic breathing increases after physiologically-relevant hypoxic-hypercapnic challenge in C57BL6 mice and suggest that further studies with these and B6AF1 and Swiss-Webster mice will help define the genetics of non-eupneic breathing.
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69
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Abstract
Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep. Features include snoring, witnessed apnoeas, and sleepiness. Pathogenesis varies; predisposing factors include small upper airway lumen, unstable respiratory control, low arousal threshold, small lung volume, and dysfunctional upper airway dilator muscles. Risk factors include obesity, male sex, age, menopause, fluid retention, adenotonsillar hypertrophy, and smoking. Obstructive sleep apnoea causes sleepiness, road traffic accidents, and probably systemic hypertension. It has also been linked to myocardial infarction, congestive heart failure, stroke, and diabetes mellitus though not definitively. Continuous positive airway pressure is the treatment of choice, with adherence of 60-70%. Bi-level positive airway pressure or adaptive servo-ventilation can be used for patients who are intolerant to continuous positive airway pressure. Other treatments include dental devices, surgery, and weight loss.
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Affiliation(s)
- Amy S Jordan
- University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia.
| | - David G McSharry
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Letterkenny General Hospital, County Donegal, Ireland
| | - Atul Malhotra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; University of California, San Diego, CA, USA
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70
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Horner RL, Hughes SW, Malhotra A. State-dependent and reflex drives to the upper airway: basic physiology with clinical implications. J Appl Physiol (1985) 2013; 116:325-36. [PMID: 23970535 DOI: 10.1152/japplphysiol.00531.2013] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The root cause of the most common and serious of the sleep disorders is impairment of breathing, and a number of factors predispose a particular individual to hypoventilation during sleep. In turn, obstructive hypopneas and apneas are the most common of the sleep-related respiratory problems and are caused by dysfunction of the upper airway as a conduit for airflow. The overarching principle that underpins the full spectrum of clinical sleep-related breathing disorders is that the sleeping brain modifies respiratory muscle activity and control mechanisms and diminishes the ability to respond to respiratory distress. Depression of upper airway muscle activity and reflex responses, and suppression of arousal (i.e., "waking-up") responses to respiratory disturbance, can also occur with commonly used sedating agents (e.g., hypnotics and anesthetics). Growing evidence indicates that the sometimes critical problems of sleep and sedation-induced depression of breathing and arousal responses may be working through common brain pathways acting on common cellular mechanisms. To identify these state-dependent pathways and reflex mechanisms, as they affect the upper airway, is the focus of this paper. Major emphasis is on the synthesis of established and recent findings. In particular, we specifically focus on 1) the recently defined mechanism of genioglossus muscle inhibition in rapid-eye-movement sleep; 2) convergence of diverse neurotransmitters and signaling pathways onto one root mechanism that may explain pharyngeal motor suppression in sleep and drug-induced brain sedation; 3) the lateral reticular formation as a key hub of respiratory and reflex drives to the upper airway.
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Affiliation(s)
- Richard L Horner
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Louis B, Papon JF, Croce C, Caillibotte G, Sbirlea-Apiou G, Coste A, Fodil R, Isabey D. Frictional resistance sheds light on the multicomponent nature of nasal obstruction: a combined in vivo and computational fluid dynamics study. Respir Physiol Neurobiol 2013; 188:133-42. [PMID: 23727227 DOI: 10.1016/j.resp.2013.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 05/19/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
Abstract
Exploring nasal flow contributes to better understanding of pathophysiological functions of nasal cavities. We combined the rhinomanometry measurements of 11 patients and computational fluid dynamics (CFD) simulations in 3 nasal airway models to dissect the complex mechanisms that determine nasal flow obstruction: spatial complexity and pressure-dependent deformability of nasal airways. We quantified spatial complexity by calculating longitudinal variations of hydraulic diameter, perimeter and area of nasal cavities, and their impact on flow characteristics by examining the longitudinal variations of the kinetic energy coefficient and the kinetic to potential energy ratio. Airway distensibility variably affected in vivo pressure-flow relationships through the appearance of flow-limitation patterns characterized by maximum flow and/or flow plateau. We quantified deformability and spatial complexity effects on nasal airway resistance by normalizing all data with averaged reference parameters. The results show that discrepancies in nasal flow resistances reflect airway deformability and geometrical complexity, and thereby constitute a framework to better characterize nasal obstruction.
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Affiliation(s)
- Bruno Louis
- Inserm, U955, Equipe 13, Cell and Respiratory Mechanics Department, 8, rue du Général Sarrail, F-94010 Créteil Cedex, France.
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Butler JP, Owens RL, Malhotra A, Wellman A. Rebuttal from James P. Butler, Robert L. Owens, Atul Malhotra and Andrew Wellman. J Physiol 2013; 591:2237. [DOI: 10.1113/jphysiol.2013.253120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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