Discriminative power of phrenic twitch-induced dynamic response for diagnosis of sleep apnea during wakefulness

Abstract

The diagnosis of the obstructive sleep apnea syndrome relies on polysomnography. Bilateral anterior magnetic phrenic stimulation (BAMPS) mimics the dissociation between upper airway (UA) muscles and diaphragm commands that leads to UA closure during sleep. We evaluated BAMPS as a mean to identify obstructive sleep apnea syndrome patients through the characterization of the UA dynamics in 28 consecutive awake patients (18 apneic and 10 nonapneic). Driving pressure (Pd) and instantaneous flow (V˙) were recorded in response to BAMPS to determine the point of flow limitation (V˙imax) and of minimal flow (V˙imin) and the flow-pressure relationship [V˙i = ( k 1× Pd) + ( k 2 × Pd2)]. V˙imax,V˙imin, UA resistance atV˙i min, and the coefficient of the flow-pressure relationship ( k 1) were correlated with apnea-hypopnea index (respectively, R = −0.735, P < 0.0001; R = −0.584, P = 0.001; R = 0.474, P= 0.01; and R = −0.567, P < 0.01). Body mass index was also correlated with apnea-hypopnea index ( R = 0.500, P < 0.01). Apneic patients had a lower V˙imax (V˙imax = 678 ± 386 vs. 1,247 ± 271 ml/s; P < 0.001), a lower V˙imin (V˙imin = 460 ± 313 vs. 822 ± 393 ml/s; P < 0.05) and a lower k 1 ( k 1 = 162 ± 67 vs. 272 ± 112 ml · cmH2O · s−1; P < 0.01) than nonapneic ones. Using a classification and regression tree approach, we found that aV˙imax of <803 ml/s ( n = 12) selected only apneic patients. When V˙imax of >803 ml/s ( n = 16), a k 1 of >266.7 ml · cmH2O · s−1identified only nonapneic patients ( n = 5). In 11 cases, V˙imax > 803 ml/s and k 1 < 266.7 ml · cmH2O · s−1. These included five nonapneic and six apneic patients. We conclude that UA dynamic properties studied with BAMPS during wakefulness significantly differ between nonapneic and apneic patients.