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Title
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Critical closing pressure (Pcrit) of the pharyngeal airway during routine drug-induced sleep endoscopy : feasibility and protocol
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Author
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Abstract
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| 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 trial aimed to investigate the feasibility and protocol of Pcrit measurements during DISE. Thirteen OSA patients 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]cmH2O, "ventilation method" (n=13):-1.32[2.32;0.47] cmH2O), 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, associated with high negative effort dependence. Subjects with palatal complete concentric collapse during DISE had a wide Pcrit range ([-2.86;2.51]cmH2O), suggesting no close correlation between Pcrit and this DISE pattern (p=0.38). Incorporation of Pcrit measurements into DISE assessments are feasible and give 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. |
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Language
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English
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Source (journal)
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Journal of applied physiology / American Physiological Society. - Washington, D.C.
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Publication
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Washington, D.C.
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2022
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ISSN
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8750-7587
[print]
1522-1601
[online]
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DOI
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10.1152/JAPPLPHYSIOL.00624.2021
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Volume/pages
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132
:4
(2022)
, p. 925-937
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ISI
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000779691300001
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Pubmed ID
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35112928
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Full text (Publisher's DOI)
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Full text (open access)
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