Relationship between airflow limitation in response to upper airway negative pressure during wakefulness and obstructive sleep apnea severity

Abstract

Purpose: The objective was to determine if alteration in airflow induced by negative pressure (NP) applied to participants' upper airways during wakefulness, is related to obstructive sleep apnea (OSA) severity as determined by the apnea-hypopnea index (AHI).

Methods: Adults 18 years of age or greater were recruited. All participants underwent overnight polysomnography to assess their apnea-hypopnea index (AHI). While awake, participants were twice exposed, orally, to -3 cm H₂O of NP for five full breaths. The ratio of the breathing volumes of the last two breaths during NP exposure to the last two breaths prior to NP exposure was deemed the NP ratio (NPR).

Results: Eighteen participants were enrolled. A strong relationship between the AHI and the exponentially transformed NPR (ExpNPR) for all participants was observed (R² = 0.55, p < 0.001). A multivariable model using the independent variable ExpNPR, age, body mass index and sex accounted for 81% of variability in AHI (p = 0.0006). A leave-one-subject-out cross-validation analysis revealed that predicted AHI using the multivariable model, and actual AHI from participants' polysomnograms, were strongly related (R² = 0.72, p < 0.001).

Conclusion: We conclude that ExpNPR, was strongly related to the AHI, independently of demographic factors known to be related to the AHI.

Keywords: Negative upper airway pressure; Obstructive sleep apnea; Upper airway collapsibility; sleep apnea diagnosis.