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Received July 23, 2002
Accepted after revision October 21, 2002
1 Centre de pneumologie Hôpital Laval, 2725, chemin Sainte-Foy, Sainte-Foy, Québec, Canada, G1V 4G5
2 Centre de recherche, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, Québec, Canada, UPRES EA 2397, Université Paris VI Pierre et Marie Curie, Paris, France, and Service de Physiologie, CHU de Rouen, France
3 UPRES EA 2397, Université Paris VI Pierre et Marie Curie, Paris, France, and Service de Pneumologie, Groupe Hospitalier Pitié-Salpêtriére, Assistance Publique - Hôpitaux de Paris, Paris, France
4 Centre de recherche, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, Québec, Canada and UPRES EA 2397, Université Paris VI Pierre et Marie Curie, Paris, France
* To whom correspondence should be addressed. E-mail: frederic.series{at}med.ulaval.ca.
Continuous positive pressure (CPAP) is the main treatment of the obstructive sleep apnoea syndrome (OSAS). We assessed its effects on the upper airway (UA) dynamics in response to bilateral anterior magnetic phrenic nerve stimulation (BAMPS) in 17 awake untreated OSAS patients (15 males; 52 ± 7 years) whose effective CPAP (Peff) had been determined beforehand by a conventional titration sleep study. All twitch-related inspirations were flow-limited, flow first rising to a maximum ( VImax), then decreasing to a minimum ( VImin), and then increasing again (M-shaped pattern). Up to VImin, the relationship between driving pressure (Pd) and flow ( V) could adequately be fitted to a polynomial regression model ( V = k1Pd + k2Pd2; r2 = 0.71-0.98, P < 0.0001). At atmospheric pressure VImax was 700 ± 377 ml s-1, VImin was 458 ± 306 ml s-1, k1 was 154.5 ± 63.9 ml s-1 (cmH2O)-1, and k2 was 10.7 ± 7.3 ml s-1 (cmH2O)-1. CPAP significantly increased VImax and VImin (peak values 1007 ± 332 ml and 837 ± 264 ml, respectively) as well as k1 and k2 (peak values 300.9 ± 178.2 ml s-1 (cmH2O)-1 and 55.2 ± 65.3 ml s-1 (cmH2O)-1, respectively). With increasing CPAP, k1/k2 increased up to a peak value before decreasing. We defined as Peff,stim the CPAP value corresponding to the highest k1/k2 value. Peff,stim was correlated with Peff (Peff = 7.0 ± 2.0; Peff,stim = 6.4 ± 2.6 cmH2O; R = 0.886, 95 % CI 0.696-0.960, P < 0.001). We conclude that CPAP improves UA dynamics in OSAS and that the therapeutic CPAP to apply can be predicted during wakefulness using BAMPS.
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