Stable Breathing in Patients With Obstructive Sleep Apnea Is Associated With Increased Effort but Not Lowered Metabolic Rate

dc.citation.issue10
dc.citation.volume40
dc.contributor.authorde Melo, Camila M. [UNIFESP]
dc.contributor.authorTaranto-Montemurro, Luigi
dc.contributor.authorButler, James P.
dc.contributor.authorWhite, David P.
dc.contributor.authorLoring, Stephen H.
dc.contributor.authorAzarbarzin, Ali
dc.contributor.authorMarques, Melania
dc.contributor.authorBerger, Philip J.
dc.contributor.authorWellman, Andrew
dc.contributor.authorSands, Scott A.
dc.coverageCary
dc.date.accessioned2020-08-04T13:40:07Z
dc.date.available2020-08-04T13:40:07Z
dc.date.issued2017
dc.description.abstractStudy objectives: In principle, if metabolic rate were to fall during sleep in a patient with obstructive sleep apnea (OSA), ventilatory requirements could be met without increased respiratory effort thereby favoring stable breathing. Indeed, most patients achieve periods of stable flow-limited breathing without respiratory events for periods during the night for reasons that are unclear. Thus, we tested the hypothesis that in patients with OSA, periods of stable breathing occur when metabolic rate (VO2) declines. Methods: Twelve OSA patients (apnea-hypopnea index > 15 events/h) completed overnight polysomnography including measurements of VO2 (using ventilation and intranasal PO2) and respiratory effort (esophageal pressure). Results: Contrary to our hypothesis, VO2 did not differ between stable and unstable breathing periods in non-REM stage 2 (208 +/- 20 vs. 213 +/- 18 mL/min), despite elevated respiratory effort during stable breathing (26 +/- 2 versus 23 +/- 2 cmH(2)O, p =.03). However, VO2 was lowered during deeper sleep (244 to 179 mL/min from non-REM stages 1 to 3, p =.04) in conjunction with more stable breathing. Further analysis revealed that airflow obstruction curtailed metabolism in both stable and unstable periods, since CPAP increased VO 2 by 14% in both cases (p =.02,.03, respectively). Patients whose VO2 fell most during sleep avoided an increase in PCO2 and respiratory effort. Conclusions: OSA patients typically convert from unstable to stable breathing without lowering metabolic rate. During sleep, OSA patients labor with increased respiratory effort but fail to satisfy metabolic demand even in the absence of overt respiratory events.en
dc.description.affiliationBrigham & Womens Hosp, Dept Med, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA
dc.description.affiliationBrigham & Womens Hosp, Dept Neurol, Div Sleep & Circadian Disorders, 75 Francis St, Boston, MA 02115 USA
dc.description.affiliationHarvard Med Sch, 221 Longwood Ave,Suite BLI038, Boston, MA 02115 USA
dc.description.affiliationUniv Fed Sao Paulo UNIFESP, Dept Psychobiol, Sao Paulo, SP, Brazil
dc.description.affiliationBeth Israel Deaconess Med Ctr, Dept Anesthesia & Crit Care, Boston, MA 02215 USA
dc.description.affiliationUniv Sao Paulo, Fac Med, Hosp Clin HCFMUSP, Heart Inst Incor,Sleep Lab,Pulm Div, Sao Paulo, SP, Brazil
dc.description.affiliationMonash Univ, Hudson Inst Med Res, Ritchie Ctr, Melbourne, Vic, Australia
dc.description.affiliationAlfred & Monash Univ, Dept Allergy Immunol & Resp Med, Melbourne, Vic, Australia
dc.description.affiliationAlfred & Monash Univ, Cent Clin Sch, Melbourne, Vic, Australia
dc.description.affiliationUnifespUniv Fed Sao Paulo UNIFESP, Dept Psychobiol, Sao Paulo, SP, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipNational Institutes of Health (NIH)
dc.description.sponsorshipHarvard Catalyst Clinical Research Center
dc.description.sponsorshipOMPA Corporation, Kaifeng, China
dc.description.sponsorshipConselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Ministry of Education of Brazil
dc.description.sponsorshipAmerican Heart Association
dc.description.sponsorshipFAPESP, Sao Paulo
dc.description.sponsorshipNational Health and Medical Research Council of Australia (NHMRC)
dc.description.sponsorshipMenzies Foundation
dc.description.sponsorshipNIH
dc.format.extent-
dc.identifierhttp://dx.doi.org/10.1093/sleep/zsx128
dc.identifier.citationSleep. Cary, v. 40, n. 10, p. -, 2017.
dc.identifier.doi10.1093/sleep/zsx128
dc.identifier.issn1550-9109
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/57302
dc.identifier.wosWOS:000413538500003
dc.language.isoeng
dc.publisherOxford Univ Press Inc
dc.relation.ispartofSleep
dc.rightsAcesso restrito
dc.subjectOSAen
dc.subjectstable breathingen
dc.subjectmetabolic rateen
dc.subjectrespiratory efforten
dc.subjectdeep sleepen
dc.titleStable Breathing in Patients With Obstructive Sleep Apnea Is Associated With Increased Effort but Not Lowered Metabolic Rateen
dc.typeArtigo
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