Document Detail


Neural drive during continuous positive airway pressure (CPAP) and pressure relief CPAP.
MedLine Citation:
PMID:  19147399     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pressure release continuous positive airway pressure (CPAP) is an evolution of CPAP that has been reported to improve patient comfort. We hypothesised the pressure release would lead to unloading of the inspiratory muscles and therefore conducted a prospective double-blind cross-over physiological study of autotitrating CPAP (APAP) against autotitrating pressure relief CPAP (PR-APAP).
METHODS: Eleven patients with severe obstructive sleep apnoea (OSA; mean AHI 74.5+/-14.4/h) were studied. We assessed neural drive by recording the oesophageal pressure, gastric pressure, transdiaphragmatic pressure and the diaphragm EMG during overnight polysomnography.
RESULTS: Both APAP and PR-APAP significantly reduced neural respiratory drive. Transdiaphragmatic pressure swings during apnoea (30.2+/-11.5 cm H2O) before treatment decreased to 9.1+/-5.3 cm H2O for PR-APAP and 8.5+/-3.7 cm H2O for APAP. The transdiaphragmatic pressure and the diaphragm EMG did not differ significantly between APAP and PR-APAP. The gastric pressure swing at expiration phase disappeared during both APAP and PR-APAP when sleep respiratory events were eliminated.
CONCLUSIONS: PR-APAP is not superior to APAP in terms of reducing neural respiratory drive. It is unnecessary to replace conventional APAP with PR-APAP for patients who have been successfully treated with traditional APAP.
Authors:
Y M Luo; Z H Qiu; H D Wu; J Steier; C Jolley; N S Zhong; J Moxham; M I Polkey
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-01-14
Journal Detail:
Title:  Sleep medicine     Volume:  10     ISSN:  1878-5506     ISO Abbreviation:  Sleep Med.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-27     Completed Date:  2010-01-29     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  100898759     Medline TA:  Sleep Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  731-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Body Mass Index
Continuous Positive Airway Pressure / methods*
Cross-Over Studies
Diaphragm / innervation
Double-Blind Method
Electrocardiography
Electromyography
Esophagus / innervation
Female
Humans
Inhalation / physiology*
Male
Middle Aged
Nerve Net / physiology*
Polysomnography
Pressure
Prospective Studies
Respiratory Muscles / physiology
Severity of Illness Index
Sleep Apnea, Obstructive / diagnosis,  physiopathology*,  therapy*
Sleep Stages
Stomach / innervation
Supine Position
Grant Support
ID/Acronym/Agency:
G0500411//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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