The influence of end-expiratory lung volume on measurements of pharyngeal collapsibility

Abstract

Changes in end-expiratory lung volume (EELV) affect upper airway stability. The passive pharyngeal critical pressure (Pcrit), a measure of upper airway collapsibility, is determined using airway pressure drops. The EELV change during these drops has not been quantified and may differ between obese obstructive sleep apnea (OSA) patients and controls. Continuous positive airway pressure (CPAP)-treated OSA patients and controls were instrumented with an epiglottic catheter, magnetometers (to measure change in EELV), and a nasal mask/pneumotachograph. Subjects slept supine in a head-out plastic chamber in which the extrathoracic pressure could be lowered (to raise EELV) while on nasal CPAP. The magnitude of EELV change during Pcrit measurement (sudden reductions of CPAP for 3–5 breaths each minute) was assessed at baseline and with EELV increased ∼500 ml. Fifteen OSA patients and 7 controls were studied. EELV change during Pcrit measurement was rapid and pressure dependent, but similar in OSA and control subjects (74 ± 36 and 59 ± 24 ml/cmH2O respectively, P = 0.33). Increased lung volume (mean +521 ml) decreased Pcrit by a similar amount in OSA and control subjects (−3.1 ± 1.7 vs. −3.9 ± 1.9 cmH2O, P = 0.31). Important lung volume changes occur during passive Pcrit measurement. However, on average, there is no difference in lung volume change for a given CPAP change between obese OSA subjects and controls. Changes in lung volume alter Pcrit substantially. This work supports a role for lung volume in the pathogenesis of OSA, and lung volume changes should be a consideration during assessment of pharyngeal mechanics.