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Critical closing pressure of the pharyngeal airway during routine drug-induced sleep endoscopy: feasibility and protocol

In obstructive sleep apnea (OSA), there are various pathophysiological factors affecting the upper airway during sleep. Two prominent factors contributing to OSA are site and pattern of upper airway collapse and degree of pharyngeal collapsibility. In a clinical setting, drug-induced sleep endoscopy...

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Autores principales: Kazemeini, Elahe, Van de Perck, Eli, Dieltjens, Marijke, Willemen, Marc, Verbraecken, Johan, Sands, Scott A., Vanderveken, Olivier M., Op de Beeck, Sara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Physiological Society 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8993534/
https://www.ncbi.nlm.nih.gov/pubmed/35112928
http://dx.doi.org/10.1152/japplphysiol.00624.2021
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author Kazemeini, Elahe
Van de Perck, Eli
Dieltjens, Marijke
Willemen, Marc
Verbraecken, Johan
Sands, Scott A.
Vanderveken, Olivier M.
Op de Beeck, Sara
author_facet Kazemeini, Elahe
Van de Perck, Eli
Dieltjens, Marijke
Willemen, Marc
Verbraecken, Johan
Sands, Scott A.
Vanderveken, Olivier M.
Op de Beeck, Sara
author_sort Kazemeini, Elahe
collection PubMed
description In obstructive sleep apnea (OSA), there are various pathophysiological factors affecting the upper airway during sleep. Two prominent factors contributing to OSA are site and pattern of upper airway collapse and degree of pharyngeal collapsibility. In a clinical setting, drug-induced sleep endoscopy (DISE) is used to visualize the structures of the upper airway. Critical closing pressure (Pcrit) is the gold standard measure of pharyngeal collapsibility. This prospective clinical study aimed to investigate the feasibility and protocol of Pcrit measurements during DISE. Thirteen patients with OSA were included. Pcrit was calculated using peak inspiratory airflow and inspiratory ventilation. The proposed protocol was successful in Pcrit measurement during DISE in all subjects [median[Q1;Q3] Pcrit for “peak inspiratory method” (n = 12): −0.84[−2.07;0.69] cmH(2)O, “ventilation method” (n = 13): −1.32[2.32;0.47] cmH(2)O], highlighting the feasibility of the approach. There was no significant difference (P = 0.67) between calculated Pcrit with either of the calculation methods, indicating high reliability. Correlation analysis showed Pcrit as an independent parameter of any of the anthropometric or polysomnographic parameters. The ventilation method proved to be more successful in assessment of Pcrit in subjects with epiglottic collapse (e.g., with high negative effort dependence). Subjects with palatal complete concentric collapse during DISE had a wide Pcrit range ([−2.86;2.51]cmH(2)O), suggesting no close correlation between Pcrit and this DISE pattern (P = 0.38). Incorporation of Pcrit measurements into DISE assessments is feasible and may yield valuable additional information for OSA management. Combining Pcrit and DISE provides information on both the site and degree of upper airway collapse and the degree of pharyngeal collapsibility. NEW & NOTEWORTHY The protocol of this study was successful in concomitant measurement of Pcrit during routine clinical endoscopy. Comparison of two calculation methods for Pcrit showed that the inspiratory ventilation method was more successful in assessment of Pcrit in subjects with epiglottic collapse who have high negative effort dependence. Subjects with palatal complete concentric collapse during DISE had a wide Pcrit range and did not have a greater Pcrit than patients in other site of collapse categories.
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spelling pubmed-89935342022-04-19 Critical closing pressure of the pharyngeal airway during routine drug-induced sleep endoscopy: feasibility and protocol Kazemeini, Elahe Van de Perck, Eli Dieltjens, Marijke Willemen, Marc Verbraecken, Johan Sands, Scott A. Vanderveken, Olivier M. Op de Beeck, Sara J Appl Physiol (1985) Research Article In obstructive sleep apnea (OSA), there are various pathophysiological factors affecting the upper airway during sleep. Two prominent factors contributing to OSA are site and pattern of upper airway collapse and degree of pharyngeal collapsibility. In a clinical setting, drug-induced sleep endoscopy (DISE) is used to visualize the structures of the upper airway. Critical closing pressure (Pcrit) is the gold standard measure of pharyngeal collapsibility. This prospective clinical study aimed to investigate the feasibility and protocol of Pcrit measurements during DISE. Thirteen patients with OSA were included. Pcrit was calculated using peak inspiratory airflow and inspiratory ventilation. The proposed protocol was successful in Pcrit measurement during DISE in all subjects [median[Q1;Q3] Pcrit for “peak inspiratory method” (n = 12): −0.84[−2.07;0.69] cmH(2)O, “ventilation method” (n = 13): −1.32[2.32;0.47] cmH(2)O], highlighting the feasibility of the approach. There was no significant difference (P = 0.67) between calculated Pcrit with either of the calculation methods, indicating high reliability. Correlation analysis showed Pcrit as an independent parameter of any of the anthropometric or polysomnographic parameters. The ventilation method proved to be more successful in assessment of Pcrit in subjects with epiglottic collapse (e.g., with high negative effort dependence). Subjects with palatal complete concentric collapse during DISE had a wide Pcrit range ([−2.86;2.51]cmH(2)O), suggesting no close correlation between Pcrit and this DISE pattern (P = 0.38). Incorporation of Pcrit measurements into DISE assessments is feasible and may yield valuable additional information for OSA management. Combining Pcrit and DISE provides information on both the site and degree of upper airway collapse and the degree of pharyngeal collapsibility. NEW & NOTEWORTHY The protocol of this study was successful in concomitant measurement of Pcrit during routine clinical endoscopy. Comparison of two calculation methods for Pcrit showed that the inspiratory ventilation method was more successful in assessment of Pcrit in subjects with epiglottic collapse who have high negative effort dependence. Subjects with palatal complete concentric collapse during DISE had a wide Pcrit range and did not have a greater Pcrit than patients in other site of collapse categories. American Physiological Society 2022-04-01 2022-02-03 /pmc/articles/PMC8993534/ /pubmed/35112928 http://dx.doi.org/10.1152/japplphysiol.00624.2021 Text en Copyright © 2022 The Authors https://creativecommons.org/licenses/by/4.0/Licensed under Creative Commons Attribution CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/) . Published by the American Physiological Society.
spellingShingle Research Article
Kazemeini, Elahe
Van de Perck, Eli
Dieltjens, Marijke
Willemen, Marc
Verbraecken, Johan
Sands, Scott A.
Vanderveken, Olivier M.
Op de Beeck, Sara
Critical closing pressure of the pharyngeal airway during routine drug-induced sleep endoscopy: feasibility and protocol
title Critical closing pressure of the pharyngeal airway during routine drug-induced sleep endoscopy: feasibility and protocol
title_full Critical closing pressure of the pharyngeal airway during routine drug-induced sleep endoscopy: feasibility and protocol
title_fullStr Critical closing pressure of the pharyngeal airway during routine drug-induced sleep endoscopy: feasibility and protocol
title_full_unstemmed Critical closing pressure of the pharyngeal airway during routine drug-induced sleep endoscopy: feasibility and protocol
title_short Critical closing pressure of the pharyngeal airway during routine drug-induced sleep endoscopy: feasibility and protocol
title_sort critical closing pressure of the pharyngeal airway during routine drug-induced sleep endoscopy: feasibility and protocol
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8993534/
https://www.ncbi.nlm.nih.gov/pubmed/35112928
http://dx.doi.org/10.1152/japplphysiol.00624.2021
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