Document Detail

A new method of negative expiratory pressure test analysis detecting upper airway flow limitation to reveal obstructive sleep apnea.
MedLine Citation:
PMID:  16236869     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Expiratory flow limitation (EFL) by negative expiratory pressure (NEP) testing, quantified as the expiratory flow-limited part of the flow-volume curve, may be influenced by airway obstruction of intrathoracic and extrathoracic origins. NEP application during tidal expiration immediately determines a rise in expiratory flow (V) followed by a short-lasting V drop (deltaV), reflecting upper airway collapsibility. PURPOSES: This study investigated if a new NEP test analysis on the transient expiratory DeltaV after NEP application for detection of upper airway V limitation is able to identify obstructive sleep apnea (OSA) subjects and its severity. METHODS: Thirty-seven male subjects (mean +/- SD age, 46 +/- 11 years; mean body mass index [BMI], 34 +/- 7 kg/m2) with suspected OSA and with normal spirometric values underwent nocturnal polysomnography and diurnal NEP testing at - 5 cm H2O and - 10 cm H2O in sitting and supine positions. RESULTS: deltaV (percentage of the peak V [%Vpeak]) was better correlated to apnea-hypopnea index (AHI) than the EFL measured as V, during NEP application, equal or inferior to the corresponding V during control (EFL), and expressed as percentage of control tidal volume (%Vt). AHI values were always high (> 44 events/h) in subjects with BMI > 35 kg/m2, while they were very scattered (range, 0.5 to 103.5 events/h) in subjects with BMI < 35 kg/m2. In these subjects, AHI still correlated to deltaV (%Vpeak) in both sitting and supine positions at both NEP pressures. CONCLUSIONS: OSA severity is better related to deltaV (%Vpeak) than EFL (%Vt) in subjects referred to sleep centers. DeltaV (%Vpeak) can be a marker of OSA, and it is particularly useful in nonseverely obese subjects.
Giuseppe Insalaco; Salvatore Romano; Oreste Marrone; Adriana Salvaggio; Giovanni Bonsignore
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Chest     Volume:  128     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-20     Completed Date:  2005-11-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2159-65     Citation Subset:  AIM; IM    
Italian National Research Council, Institute of Biomedicine and Molecular Immunology A. Monroy, Section of Respiratory Pathophysiology, Via Ugo La Malfa, 153-90146 Palermo, Italy.
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MeSH Terms
Body Mass Index
Middle Aged
Patient Selection
Positive-Pressure Respiration / methods*
Reproducibility of Results
Respiratory Function Tests*
Sleep Apnea Syndromes / physiopathology*,  therapy*

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