Indian Journal of Sleep Medicine

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VOLUME 2 , ISSUE 1 ( January-March, 2007 ) > List of Articles

ORIGINAL ARTICLE

Pulmonary Functions in Obstructive Sleep Apnea Hypopnea Syndrome in a Cohort of Patients Attending the Sleep Center of a Tertiary Care Hospital

J. C. Suri

Citation Information : Suri JC. Pulmonary Functions in Obstructive Sleep Apnea Hypopnea Syndrome in a Cohort of Patients Attending the Sleep Center of a Tertiary Care Hospital. Indian Sleep Med 2007; 2 (1):21-27.

DOI: 10.5005/ijsm-2-1-21

License: NA

Published Online: 01-06-2018

Copyright Statement:  NA


Abstract

Eighty-nine patients (70 male and 19 female) of obstructive sleep apnea were retrospectively studied. Material and Methods A detailed history was obtained and general physical, systemic and ENT examination performed. Their pulmonary function test reports, which included FVC, SVC, PEFR, PIFR, FEF25-75, flow-volume loop analysis, were interpreted. An arterial blood gas analysis (at rest, with the patient breathing room air during daytime) was obtained. A whole night fully supervised, manually validated, level-I complete polysomnography was conducted on all patients. Various sleep-study parameters (which included apnea, hypopnea, flow-limitation, RDI, arousal index, minimum oxygen saturation during sleep and desaturation index) were obtained. Results Among the 89 patients, 39 had mild obstructive sleep apnea (OSA) (RDI 5-19), 26 had moderate OSA (RDI 19-39), and 24 had severe OSA (RDI>40). The average BMI of the patient population was 29.54 +1.16. There was a mild restrictive ventilatory impairment in the study population. The mean value of PEFR / PIFR ratio was 1.47 and was found to be >1 in 92.6% patients, thus indicating significant upper airway obstructive pattern. The flow-volume loops showed flattening of the inspiratory limb in 62% of the patients and characteristic saw-tooth pattern / undulations in 35% of the patients. The mean PaO2 was 73.85 mmHg indicating significant hypoxemia. There was a decreasing trend in the PaO2 value with increase in severity of sleep-disordered breathing. No significant correlations were observed between pulmonary function test variables (SVC, FVC, FEF25-75, PEFR and FEV1/FVC) and the severity of OSA i.e. RDI, minimum O2 saturation and desaturation index. However arousal index was found to correlate positively with the FVC (p=.0783) and SVC (p=.0545) (expressed as a percentage of the predicted value) respectively. There was also a significant negative correlation between daytime arterial PaO2 and RDI (p=0.0477), arousal index (p=0.0592), minimum O2 saturation (p=0.0458) and desaturation index (p=0.0316). A significant negative correlation was also seen between the PEFR / PIFR ratio and desaturation index (p=0.0515). Conclusion On the basis of the present study it can be concluded that in a patient who presents with history suggestive of sleep disordered breathing, the presence of daytime hypoxemia, flattening of inspiratory limb of the flow volume loop with a PEFR/PIFR ratio>1 strengthen the suspicion of OSAS.


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  1. Lugaresi E, Cirignotta F, Coccagna G, Pianna C. Some epidemiological data on snoring and cardiocirculatory disturbances. Sleep 1980; 3:221-224.
  2. Pillar G, Peled N, Katz N, Lavie P. Predictive value of specific risk factors, symptoms and signs, in diagnosing obstructive sleep apnea and its severity. J Sleep Res 1992; 3:241- 244.
  3. Kump K, Whalen C, Tishler P, Browner I, Ferrette V, Strohl K, Rosenberg C, Redline S. Assessment of validity and utility of a sleep-symptom questionnaire. Am J Respir Crit Care Med 1994; 150; 735-741.
  4. Crocker B, Olson L, saunders n, Hensley M, McKeon J, Murree Allen K, Gyulay S. Estimation of the probability of disturbed breathing during sleep before a sleep study. Am Rev Respir Dis 1990;142:14-18.
  5. Flemons W, Whitelaw w, Brant R, Remmers J. Likelihood ratios for a sleep apnea clinical prediction rule. Am Rev Respir Dis 1994;150:1279-1285.
  6. Viner S, Szalai J, Hoffstein V. Are history and physical examination a good screening test for sleep apnea. Ann Intern Med 1991; 115:356-359.
  7. Zerah-Lancer F, Lofaso F, D'Ortho M P, Delclauxe C, Goldenberg F, Coste A, Housset B, Harf A. Predictive value of pulmonary function test parameters for sleep apnea syndrome Am J Respir Crit Care Med 2000; 162:2208- 2212.
  8. Zerah-Lancer F, Lofaso F, Coste A, Ricolfi F, Goldenberg F, Harf A. Pulmonary functions in obese snorers with or without sleep apnea syndrome. Am J Respir Crit Care Med 1997; 156:522-527.
  9. Kreiger J, Weitzenblum E, Vandervenne A, Stierle J L, Kurtz D. Flow-volume curve abnormalities and obstructive sleep apnea syndrome. Chest 1985; 87 (2):163-167.
  10. Campbell A H, Guy P A, Rochford P D, Worsnop C J, Pierce R J. Flow-volume changes in patients with obstructive sleep apnoea and brief upper airway dysfunction. Respirology 2000; 5(1): 11-18.
  11. Neukirch F., Wietzenblum E., Liard R., Korbaeff M., Henry C. et al. Frequency and the correlates of the saw-tooth pattern of flow-volume curves in an epidemiological survey. Chest 1992; 101:425-431.
  12. Tammelin B.R., Wilson A.F., de Berry B., Sassin J. Flow volume curves reflect pharyngeal airway abnormalities in sleep apnea yndrome. Am Rev Respir Dis 1983; 126:712- 715.
  13. Hoffstein V, Wright S, Zamel N. Flow volume curves in snoring patients with and without obstructive sleep apnea. Am Rev Respir Dis 1989;139:957-960.
  14. Katz I.N., Zamel N., Slutsky S, Rebuck S, Hoffstein V. An evaluation of flow-volume curve as a screening test of obstructive sleep apnea. Chest 1990;98;337-340.
  15. Jequier, E. Energy, obesity, and body weight standards. Am J Clin. Nutr. 1987; 45:1035-1047.
  16. Rechtshaffen A, Kales A. 1968. A manual of standardized terminology, techniques and scoring system for sleep stages of human sleep. National Institutes of Health, US Government Printing Office, Washington, D.C., Publication No. 204.
  17. American Academy of Sleep Medicine Task Force. Sleeprelated breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999; 22:667-689.
  18. Bradley T.D., Rutherford R, Lue F, Moldofsky H grossmann R.F.,Zamel N, Phillipson E.A. Role of diffuse airway obstruction in the hypercapnia of obstructive sleep apnea. Am Rev Respir Dis 1986; 134:920-924.
  19. Kreiger J, Sforza E, Apprill M, Lampert E, Weitzenblum E, Rotomaharo J. Pulmonary hypertension, hypoxemia and hypercapnia in obstructive sleep apnea patients. Chest 1989;96:729-737.
  20. Weitzenblum E, Kreiger M, Apprill E, Vallee E, Ehrhart M, Ratomaharo J, Oswald M, Kurtz D. Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am Rev Respir Dis 1988; 138:345-349.
  21. Wetter D.W., Young T.B., Bidweel T.R., Badr S, Palta M. Smoking as a risk factor for sleep disordered breathing. Arch Intern Med 1994; 154:2219-2224.
  22. Appel berg J, Nordahl G, janson C. Lung volume and its correlation to nocturnal apnoea and desaturation. Respir Med 2000; 94:(3):233-239.
  23. Weitzenblum, E., J. Krieger, M. Oswald, A. Chaouat, P. Bachez and R. Kessler. Chronic obstructive pulmonary disease and sleep apnea syndrome. Sleep 1992;15:33- 35.
  24. Chaouat, A., E. Weitzenblum, J. Krieger, T. Ifoundza, M. Oswald and R. Kessler. Association of Chrnic obstructive pulmonary disease and sleep apnea syndrome. Am. J. Respir Crit Care Med 1995;151:82-86.
  25. Shore ET, Millman RP. Abnormalities in the flow-volume loop in obstructive sleep apnoea sitting and supine. 1984 Thorax Oct;39(10):775-9.
  26. Haponic E. F., Bleecker E. R, Allen R. P., Smith P. L., Kaplan J. Abnormal inspiratory flow-volume curves in patients with sleep-disordered breathing. Am Rev Respir Dis.1981;124(5):571-4.
  27. Hoffstein V, Oliver Z. Pulmonary function and sleep apnea. Sleep Breath, 2003;7(4):159-65.
  28. Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N. Engl J Med 1993;328:1230-1235.
  29. Lavie P. Incidence of sleep apnea in a presumably healthy working population. Sleep 1983;6:312-318.
  30. Kushida CA, Efron B, Guilleminault C. a predictive morphometric model for obstructive sleep apnea syndrome. Ann Intern Med 1997;127:581-587.
  31. Redline S, Strohl K P. Recognition of obstructive sleep apnea.
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