Quantification of airway conductance from noninvasive ventilatory drive in patients with sleep apnea.
Quantification of airway conductance from noninvasive ventilatory drive in patients with sleep apnea.
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睡眠呼吸暂停患者无创通气驱动气道传导的量化。
DOI：
10.1152/japplphysiol.00387.2021
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Rapoport,DavidM
中科院分区：
文献类型：
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作者：
Tolbert,ThomasM;Parekh,Ankit;Sands,ScottA;Mooney,AnneM;Ayappa,Indu;Rapoport,DavidM
上气道传导率，吸气气流与吸气努力的比率，量化了睡眠呼吸暂停中观察到的呼吸不足时的气道阻塞程度。我们评估了通气与无创性呼吸驱动的比率作为传导的替代。此外，我们开发并测试了一种改进的无创驱动，将吸气流量，压力和驱动的相互作用，以更好地估计电导。根据现有的多导睡眠图研究，对18例已知或疑似睡眠呼吸暂停的患者进行食管导管插入术，总计1，517例NREM睡眠期间的呼吸不足。对于每种呼吸不足，参考标准电导计算为吸气期间峰值吸气流量与食管压力变化的比率。使用Terrill等人开发的算法计算通气驱动，然后根据是否存在流量限制进行数学修改，以无创估计食管压力。将通气与呼吸驱动的比值和吸气峰流量与估计食管压力的比值分别与所有呼吸不足的参考标准和个体患者的中位数进行比较。呼吸不足通气与驾驶比率与参考标准的相关性有限（R2= 0.17，个体呼吸不足;R2= 0.03，患者中值）。将驱动修改为估计压力产生了估计电导，其与参考标准电导密切相关（R2= 0.49，个体呼吸不足;R2= 0.77，患者中值）。我们的结论是，呼吸不足期间气道阻塞的严重程度可以估计从非侵入性驱动器占机械流量对pressure.NEW & NOTEWORTHY阻塞性（减少上气道传导）或中央（减少吸气流量相称的努力减少）呼吸不足的分类是复杂的侵入性方法，如食管测压的要求。在这里，我们证明了使用一些食管压力测量来解释吸气流量，压力和无创呼吸驱动之间的相互作用，可以估计上气道传导。进一步的研究可能会使用这些发现来完全无创地量化气道阻塞。
Upper airway conductance, the ratio of inspiratory airflow to inspiratory effort, quantifies the degree of airway obstruction in hypopneas observed in sleep apnea. We evaluated the ratio of ventilation to noninvasive ventilatory drive as a surrogate of conductance. Furthermore, we developed and tested a refinement of noninvasive drive to incorporate the interactions of inspiratory flow, pressure, and drive to better estimate conductance. Hypopneas were compiled from existing polysomnography studies with esophageal catheterization in 18 patients with known or suspected sleep apnea, totaling 1,517 hypopneas during NREM sleep. For each hypopnea, reference standard conductance was calculated as the ratio of peak inspiratory flow to esophageal pressure change during inspiration. Ventilatory drive was calculated using the algorithm developed by Terrill et al. and then mathematically modified according to the presence or absence of flow limitation to noninvasively estimate esophageal pressure. The ratio of ventilation to ventilatory drive and the ratio of peak inspiratory flow to estimated esophageal pressure were each compared with the reference standard for all hypopneas and for median values from individual patients. Hypopnea ventilation to drive ratios were of limited correlation with the reference standard (R2= 0.17, individual hypopneas;R2= 0.03, median patient values). Modification of drive to estimated pressure yielded estimated conductance, which strongly correlated with reference standard conductance (R2= 0.49, individual hypopneas;R2= 0.77, median patient values). We conclude that the severity of airway obstruction during hypopneas may be estimated from noninvasive drive by accounting for mechanical effects of flow on pressure.NEW & NOTEWORTHYClassification of hypopneas as obstructive (decreased upper airway conductance) or central (decreased inspiratory flow commensurate with decreased effort) is complicated by the requirement of invasive methods, such as esophageal manometry. Here, we demonstrate that using a few esophageal pressure measurements to account for the interactions between inspiratory flow, pressure, and noninvasive ventilatory drive allows estimation of upper airway conductance. Further studies may use these findings to quantify airway obstruction completely noninvasively.