The online version of this article (doi:10.1186/s12890-015-0063-6) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
AA and NFL conceived and planned the program. YPZ, MHZ and YLDS recorded the patients’ information. YCW and XGY analyzed the data. TY contributed to the writing of the manuscript. All authors read and approved the final manuscript.
Even through narrowing of the upper-airway plays an important role in the generation of obstructive sleep apnea (OSA), the peripheral airways is implicated in pre-obese and obese OSA patients, as a result of decreased lung volume and increased lung elastic recoil pressure, which, in turn, may aggravate upper-airway collapsibility.
A total of 263 male (n = 193) and female (n = 70) subjects who were obese to various degrees without a history of lung diseases and an expiratory flow limitation, but troubled with snoring or suspicion of OSA were included in this cross-sectional study. According to nocturnal-polysomnography the subjects were distributed into OSA and non-OSA groups, and were further sub-grouped by gender because of differences between males and females, in term of, lung volume size, airway resistance, and the prevalence of OSA among genders. Lung volume and respiratory mechanical properties at different-frequencies were evaluated by plethysmograph and an impulse oscillation system, respectively.
Functional residual capacity (FRC) and expiratory reserve volume were significantly decreased in the OSA group compared to the non-OSA group among males and females. As weight and BMI in males in the OSA group were greater than in the non-OSA group (90 ± 14.8 kg vs. 82 ± 10.4 kg, p < 0.001; 30.5 ± 4.2 kg/m2 vs. 28.0 ± 3.0 kg/m2, p < 0.001), multiple regression analysis was required to adjust for BMI or weight and demonstrated that these lung volumes decreases were independent from BMI and associated with the severity of OSA. This result was further confirmed by the female cohort. Significant increases in total respiratory resistance and decreases in respiratory conductance (Grs) were observed with increasing severity of OSA, as defined by the apnea-hypopnea index (AHI) in both genders. The specific Grs (sGrs) stayed relatively constant between the two groups in woman, and there was only a weak association between AHI and sGrs among man. Multiple-stepwise-regression showed that reactance at 5 Hz was highly correlated with AHI in males and females or hypopnea index in females, independently-highly correlated with peripheral-airway resistance and significantly associated with decreasing FRC.
Total respiratory resistance and peripheral airway resistance significantly increase, and its inverse Grs decrease, in obese patients with OSA in comparison with those without OSA, and are independently associated with OSA severity. These results might be attributed to the abnormally increased lung elasticity recoil pressure on exhalation, due to increase in lung elasticity and decreased lung volume in obese OSA.
Additional file 1: Figure S1. Relationships between functional residual capacity (FRC) and expiratory reserve volume (ERV) for the two study groups. A: Male subjects showed a close correlation between FRC and ERV. B: Female subjects also showed a close correlation between FRC and ERV.12890_2015_63_MOESM1_ESM.tiff
Additional file 2: Figure S2. Correlation between functional residual capacity (FRC) and respiratory resistance.12890_2015_63_MOESM2_ESM.tiff
Van de Graaff WB. Thoracic influence on upper airway patency. J Appl Physiol (1985). 1988;65:2124–31.
Kairaitis K, Byth K, Parikh R, Stavrinou R, Wheatley JR, Amis TC. Tracheal traction effects on upper airway patency in rabbits: the role of tissue pressure. Sleep. 2007;30:179–86. PubMed
Owens RL, Malhotra A, Eckert DJ, White DP, Jordan AS. The influence of end-expiratory lung volume on measurements of pharyngeal collapsibility. J Appl Physiol (1985). 2010;108:445–51. CrossRef
Tagaito Y, Isono S, Remmers JE, Tanaka A, Nishino T. Lung volume and collapsibility of the passive pharynx in patients with sleep-disordered breathing. J Appl Physiol (1985). 2007;103:1379–85. CrossRef
Squier SB, Patil SP, Schneider H, Kirkness JP, Smith PL, Schwartz AR. Effect of end-expiratory lung volume on upper airway collapsibility in sleeping men and women. J Appl Physiol (1985). 2010;109:977–85. CrossRef
Heinzer RC, Stanchina ML, Malhotra A, Fogel RB, Patel SR, Jordan AS, et al. Lung volume and continuous positive airway pressure requirements in obstructive sleep apnea. Am J Respir Crit Care Med. 2005;172:114–7.
Heinzer RC, Stanchina ML, Malhotra A, Jordan AS, Patel SR, Lo YL, et al. Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax. 2006;61:435–9.
Series F, Marc I. Influence of lung volume dependence of upper airway resistance during continuous negative airway pressure. J Appl Physiol (1985). 1994;77:840–4.
Toumpanakis D, Kastis GA, Zacharatos P, Sigala I, Michailidou T, Kouvela M, et al. Inspiratory resistive breathing induces acute lung injury. Am J Respir Crit Care Med. 2010;182:1129–36.
Van de Graaff WB. Thoracic traction on the trachea: mechanisms and magnitude. J Appl Physiol (1985). 1991;70:1328–36.
Zerah-Lancner F, Lofaso F, d’Ortho MP, Delclaux C, Goldenberg F, Coste A, et al. Predictive value of pulmonary function parameters for sleep apnea syndrome. Am J Respir Crit Care Med. 2000;162:2208–12.
Bei-Fan Z, Cooperative Meta-Analysis Group of Working Group on Obesity in C. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Asia Pac J Clin Nutr. 2002;11 Suppl 8:S685–693. CrossRef
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.
Epstein LJ, Kristo D, Strollo PJ, Jr., Friedman N, Malhotra A, Patil SP, Ramar K, et al. Clinical guideline for the evaluation, management and longtermcare of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–76.
Oostveen E, MacLeod D, Lorino H, Farre R, Hantos Z, Desager K, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J. 2003;22:1026–41.
Babb TG, DeLorey DS, Wyrick BL, Gardner PP. Mild obesity does not limit change in end-expiratory lung volume during cycling in young women. J Appl Physiol (1985). 2002;92:2483–90. CrossRef
Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest. 2006;130:827–33.
Ross SD, Sheinhait IA, Harrison KJ, Kvasz M, Connelly JE, Shea SA, et al. Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnea. Sleep. 2000;23:519–32.
Hoffstein V, Zamel N, Phillipson EA. Lung volume dependence of pharyngeal cross-sectional area in patients with obstructive sleep apnea. Am Rev Respir Dis. 1984;130:175–8. PubMed
Rubinstein I, Hoffstein V, Bradley TD. Lung volume-related changes in the pharyngeal area of obese females with and without obstructive sleep apnoea. Eur Respir J. 1989;2:344–51. PubMed
Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol (1985). 2005;99:1592–9. CrossRef
Pelosi P, Croci M, Ravagnan I, Tredici S, Pedoto A, Lissoni A, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg. 1998;87:654–60.
Behazin N, Jones SB, Cohen RI, Loring SH. Respiratory restriction and elevated pleural and esophageal pressures in morbid obesity. J Appl Physiol (1985). 2010;108:212–8. CrossRef
Lorino AM, Hamoudi K, Lofaso F, Dahan E, Mariette C, Harf A, et al. Effects of continuous negative airway pressure on lung volume and respiratory resistance. J Appl Physiol (1985). 1999;87:605–10.
- Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II