Prolonged partial upper airway obstruction during sleep – an underdiagnosed phenotype of sleep-disordered breathing

References

• Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005; 365: 1046–53.
   PubMed Web of Science ®Google Scholar
• Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, Almeida-Gonzalez C, Catalan-Serra P, Montserrat JM. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Intern Med. 2012; 156: 115–22.
   PubMed Web of Science ®Google Scholar
• Tkacova R, McNicholas WT, Javorsky M, Fietze I, Sliwinski P, Parati G, etal. Nocturnal intermittent hypoxia predicts prevalent hypertension in the European Sleep Apnoea Database cohort study. Eur Respir J. 2014; 44: 931–41.
   PubMed Web of Science ®Google Scholar
• Kent BD, Grote L, Ryan S, Pepin JL, Bonsignore MR, Tkacova R, etal. Diabetes mellitus prevalence and control in sleep-disordered breathing: the European Sleep Apnea Cohort (ESADA) study. Chest. 2014; 146: 982–90.
   PubMed Web of Science ®Google Scholar
• Kent BD, Grote L, Bonsignore MR, Saaresranta T, Verbraecken J, Levy P, etal. Sleep apnoea severity independently predicts glycaemic health in nondiabetic subjects: the ESADA study. Eur Respir J. 2014; 44: 130–9.
   PubMed Web of Science ®Google Scholar
• Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn BV. The AASM manual for the scoring of sleep and associated events; rules, terminology and technical specifications. 2012; Darien, IL: American Academy of Sleep Medicine.
   Google Scholar
• Hudgel DW. ‘Apnea index’: need for improving the description of respiratory variability during sleep. Am Rev Respir Dis. 1986; 133: 708–9.
   Google Scholar
• Polo O, Brissaud L, Sales B, Besset A, Billiard M. The validity of the static charge sensitive bed in detecting obstructive sleep apnoeas. Eur Respir J. 1988; 1: 330–6.
   PubMed Web of Science ®Google Scholar
• Polo OJ, Tafti M, Fraga J, Porkka KV, Dejean Y, Billiard M. Why don't all heavy snorers have obstructive sleep apnea?. Am Rev Respir Dis. 1991; 143: 1288–93.
   Google Scholar
• Tenhunen M, Elomaa E, Sistonen H, Rauhala E, Himanen SL. Emfit movement sensor in evaluating nocturnal breathing. Respir Physiol Neurobiol. 2013; 187: 183–9.
   Web of Science ®Google Scholar
• Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000; 342: 1378–84.
   PubMed Web of Science ®Google Scholar
• Anttalainen U, Saaresranta T, Kalleinen N, Aittokallio J, Vahlberg T, Polo O. CPAP adherence and partial upper airway obstruction during sleep. Sleep Breath. 2007; 11: 171–6.
   PubMed Web of Science ®Google Scholar
• Polo-Kantola P, Rauhala E, Helenius H, Erkkola R, Irjala K, Polo O. Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy. Obstet Gynecol. 2003; 102: 68–75.
   PubMed Web of Science ®Google Scholar
• Rauhala E, Himanen SL, Saastamoinen A, Polo O. Prolonged spiking in the Emfit sensor in patients with sleep-disordered breathing is characterized by increase in transcutaneous carbon dioxide. Physiol Meas. 2007; 28: 1163–73.
   Web of Science ®Google Scholar
• Rimpilä V, Hosokawa K, Huhtala H, Saaresranta T, Salminen AV, Polo O. Transcutaneous carbon dioxide during sleep-disordered breathing. Respir Physiol Neurobiol. 2015; 219: 95–102.
   Web of Science ®Google Scholar
• Tenhunen M, Rauhala E, Virkkala J, Polo O, Saastamoinen A, Himanen SL. Increased respiratory effort during sleep is non-invasively detected with movement sensor. Sleep Breath. 2011; 15: 737–46.
   Web of Science ®Google Scholar
• Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest. 1993; 104: 781–7.
   PubMed Web of Science ®Google Scholar
• Schwartz AR, Smith PL, Wise RA, Gold AR, Permutt S. Induction of upper airway occlusion in sleeping individuals with subatmospheric nasal pressure. J Appl Physiol (1985). 1988; 64: 535–42.
   PubMed Web of Science ®Google Scholar
• Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-nerve activity during sleep in normal subjects. N Engl J Med. 1993; 328: 303–7.
   PubMed Web of Science ®Google Scholar
• Carberry JC, Jordan AS, White DP, Wellman A, Eckert DJ. Upper airway collapsibility (Pcrit) and pharyngeal dilator muscle activity are sleep stage dependent. Sleep. 2016; 39: 511–21.
   PubMed Web of Science ®Google Scholar
• Henke KG, Dempsey JA, Kowitz JM, Skatrud JB. Effects of sleep-induced increases in upper airway resistance on ventilation. J Appl Physiol (1985). 1990; 69: 617–24.
   Web of Science ®Google Scholar
• Lo YL, Jordan AS, Malhotra A, Wellman A, Heinzer RC, Schory K, etal. Genioglossal muscle response to CO2 stimulation during NREM sleep. Sleep. 2006; 29: 470–7.
   PubMed Web of Science ®Google Scholar
• Schneider H, Krishnan V, Pichard LE, Patil SP, Smith PL, Schwartz AR. Inspiratory duty cycle responses to flow limitation predict nocturnal hypoventilation. Eur Respir J. 2009; 33: 1068–76.
   Web of Science ®Google Scholar
• Stoohs R, Guilleminault C. Snoring during NREM sleep: respiratory timing, esophageal pressure and EEG arousal. Respir Physiol. 1991; 85: 151–67.
   PubMedGoogle Scholar
• Hoshino Y, Ayuse T, Kurata S, Ayuse T, Schneider H, Kirkness JP, etal. The compensatory responses to upper airway obstruction in normal subjects under propofol anesthesia. Respir Physiol Neurobiol. 2009; 166: 24–31.
   Web of Science ®Google Scholar
• Rimpilä V, Saaresranta T, Huhtala H, Virkki A, Salminen AV, Polo O. Transcutaneous CO(2) plateau as set-point for respiratory drive during upper airway flow-limitation. Respir Physiol Neurobiol. 2014; 191: 44–51.
   Web of Science ®Google Scholar
• Smith PL, Wise RA, Gold AR, Schwartz AR, Permutt S. Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol (1985). 1988; 64: 789–95.
   PubMed Web of Science ®Google Scholar
• Patil SP, Schneider H, Marx JJ, Gladmon E, Schwartz AR, Smith PL. Neuromechanical control of upper airway patency during sleep. J Appl Physiol (1985). 2007; 102: 547–56.
   PubMed Web of Science ®Google Scholar
• Kimoff RJ, Sforza E, Champagne V, Ofiara L, Gendron D. Upper airway sensation in snoring and obstructive sleep apnea. Am J Respir Crit Care Med. 2001; 164: 250–5.
   PubMed Web of Science ®Google Scholar
• Calero G, Farre R, Ballester E, Hernandez L, Daniel N, Montserrat Canal JM. Physiological consequences of prolonged periods of flow limitation in patients with sleep apnea hypopnea syndrome. Respir Med. 2006; 100: 813–7.
   Web of Science ®Google Scholar
• Anttalainen U, Saaresranta T, Aittokallio J, Kalleinen N, Vahlberg T, Virtanen I, etal. Impact of menopause on the manifestation and severity of sleep-disordered breathing. Acta Obstet Gynecol Scand. 2006; 85: 1381–8.
   PubMed Web of Science ®Google Scholar
• Condos R, Norman RG, Krishnasamy I, Peduzzi N, Goldring RM, Rapoport DM. Flow limitation as a noninvasive assessment of residual upper-airway resistance during continuous positive airway pressure therapy of obstructive sleep apnea. Am J Respir Crit Care Med. 1994; 150: 475–80.
   PubMed Web of Science ®Google Scholar
• Montserrat JM, Farre R, Ballester E, Felez MA, Pasto M, Navajas D. Evaluation of nasal prongs for estimating nasal flow. Am J Respir Crit Care Med. 1997; 155: 211–5.
   PubMed Web of Science ®Google Scholar
• Ayappa I, Rapoport DM. The upper airway in sleep: physiology of the pharynx. Sleep Med Rev. 2003; 7: 9–33.
   PubMed Web of Science ®Google Scholar
• Aittokallio T, Nevalainen O, Pursiheimo U, Saaresranta T, Polo O. Classification of nasal inspiratory flow shapes by attributed finite automata. Comput Biomed Res. 1999; 32: 34–55.
   PubMedGoogle Scholar
• Aittokallio T, Saaresranta T, Polo-Kantola P, Nevalainen O, Polo O. Analysis of inspiratory flow shapes in patients with partial upper-airway obstruction during sleep. Chest. 2001; 119: 37–44.
   Web of Science ®Google Scholar
• Bao G, Guilleminault C. Upper airway resistance syndrome – one decade later. Curr Opin Pulm Med. 2004; 10: 461–7.
   PubMed Web of Science ®Google Scholar
• Hernandez L, Ballester E, Farre R, Badia JR, Lobelo R, Navajas D, etal. Performance of nasal prongs in sleep studies: spectrum of flow-related events. Chest. 2001; 119: 442–50.
   Web of Science ®Google Scholar
• Johnson PL, Edwards N, Burgess KR, Sullivan CE. Detection of increased upper airway resistance during overnight polysomnography. Sleep. 2005; 28: 85–90.
   Web of Science ®Google Scholar
• Heitman SJ, Atkar RS, Hajduk EA, Wanner RA, Flemons WW. Validation of nasal pressure for the identification of apneas/hypopneas during sleep. Am J Respir Crit Care Med. 2002; 166: 386–91.
   Web of Science ®Google Scholar
• Lorino AM, Lorino H, Dahan E, d'Ortho MP, Coste A, Harf A, etal. Effects of nasal prongs on nasal airflow resistance. Chest. 2000; 118: 366–71.
   Web of Science ®Google Scholar
• Knaack L, Blum HC, Hohenhorst W, Ryba J, Guilleminault C, Stoohs RA. Comparison of diaphragmatic EMG and oesophageal pressure in obstructed and unobstructed breathing during sleep. Somnologie. 2005; 9: 159–65.
   Google Scholar
• Chokroverty S. Sleep disorders medicine: basic science, technical considerations, and clinical aspects. 1994; Boston: Butterworth-Heinemann.
   Google Scholar
• Farre R, Montserrat JM, Navajas D. Noninvasive monitoring of respiratory mechanics during sleep. Eur Respir J. 2004; 24: 1052–60.
   PubMed Web of Science ®Google Scholar
• Vandenbussche NL, Overeem S, van Dijk JP, Simons PJ, Pevernagie DA. Assessment of respiratory effort during sleep: esophageal pressure versus noninvasive monitoring techniques. Sleep Med Rev. 2015; 24: 28–36.
   Web of Science ®Google Scholar
• Tenhunen M, Hasan J, Himanen SL. Assessment of respiratory effort during sleep with noninvasive techniques. Sleep Med Rev. 2015; 24: 103–4.
   Web of Science ®Google Scholar
• Kirjavainen T, Polo O, McNamara S, Vaahtoranta K, Sullivan CE. Respiratory challenge induces high frequency spiking on the static charge sensitive bed (SCSB). Eur Respir J. 1996; 9: 1810–5.
   Web of Science ®Google Scholar
• Alihanka J. Basic principles for analysing and scoring Bio-Matt (SCSB) recordings. 1987; Turku: University of Turku. 1–129. Vol. D26. Typopress Oy.
   Google Scholar
• Cracowski C, Pepin JL, Wuyam B, Levy P. Characterization of obstructive nonapneic respiratory events in moderate sleep apnea syndrome. Am J Respir Crit Care Med. 2001; 164: 944–8.
   Web of Science ®Google Scholar
• Palombini LO, Tufik S, Rapoport DM, Ayappa IA, Guilleminault C, de Godoy LB, etal. Inspiratory flow limitation in a normal population of adults in Sao Paulo, Brazil. Sleep. 2013; 36: 1663–8.
   PubMed Web of Science ®Google Scholar
• Anttalainen U, Saaresranta T, Kalleinen N, Aittokallio J, Vahlberg T, Polo O. Gender differences in age and BMI distributions in partial upper airway obstruction during sleep. Respir Physiol Neurobiol. 2007; 159: 219–26.
   PubMed Web of Science ®Google Scholar
• O'Connor C, Thornley KS, Hanly PJ. Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med. 2000; 161: 1465–72.
   PubMed Web of Science ®Google Scholar
• Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328: 1230–5.
   PubMed Web of Science ®Google Scholar
• Guilleminault C, Black JE, Palombini L, Ohayon M. A clinical investigation of obstructive sleep apnea syndrome (OSAS) and upper airway resistance syndrome (UARS) patients. Sleep Med. 2000; 1: 51–6.
   PubMed Web of Science ®Google Scholar
• Mohsenin V. Gender differences in the expression of sleep-disordered breathing: role of upper airway dimensions. Chest. 2001; 120: 1442–7.
   PubMed Web of Science ®Google Scholar
• Young T, Hutton R, Finn L, Badr S, Palta M. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms?. Arch Intern Med. 1996; 156: 2445–51.
   PubMed Web of Science ®Google Scholar
• Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P. Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep. 2007; 30: 312–9.
   PubMed Web of Science ®Google Scholar
• Svensson M, Franklin KA, Theorell-Haglow J, Lindberg E. Daytime sleepiness relates to snoring independent of the apnea-hypopnea index in women from the general population. Chest. 2008; 134: 919–24.
   Web of Science ®Google Scholar
• Anttalainen U, Polo O, Vahlberg T, Saaresranta T. Women with partial upper airway obstruction are not less sleepy than those with obstructive sleep apnea. Sleep Breath. 2013; 17: 873–6.
   Web of Science ®Google Scholar
• Narkiewicz K, Somers VK. Sympathetic nerve activity in obstructive sleep apnoea. Acta Physiol Scand. 2003; 177: 385–90.
   PubMedGoogle Scholar
• Anttalainen U, Polo O, Saaresranta T. Is ‘MILD’ sleep-disordered breathing in women really mild?. Acta Obstet Gynecol Scand. 2010; 89: 605–11.
   Web of Science ®Google Scholar
• Chan CS, Bye PT, Woolcock AJ, Sullivan CE. Eucapnia and hypercapnia in patients with chronic airflow limitation. The role of the upper airway. Am Rev Respir Dis. 1990; 141: 861–5.
   Google Scholar
• Guilleminault C, Stoohs R, Shiomi T, Kushida C, Schnittger I. Upper airway resistance syndrome, nocturnal blood pressure monitoring, and borderline hypertension. Chest. 1996; 109: 901–8.
   Web of Science ®Google Scholar
• Lofaso F, Coste A, Gilain L, Harf A, Guilleminault C, Goldenberg F. Sleep fragmentation as a risk factor for hypertension in middle-aged nonapneic snorers. Chest. 1996; 109: 896–900.
   Web of Science ®Google Scholar
• Anttalainen U, Polo O, Vahlberg T, Saaresranta T. Reimbursed drugs in patients with sleep-disordered breathing: a static-charge-sensitive bed study. Sleep Med. 2010; 11: 49–55.
   Web of Science ®Google Scholar
• Tenhunen M, Hyttinen J, Lipponen JA, Virkkala J, Kuusimaki S, Tarvainen MP, etal. Heart rate variability evaluation of Emfit sleep mattress breathing categories in NREM sleep. Clin Neurophysiol. 2015; 126: 967–74.
   Web of Science ®Google Scholar
• Edwards N, Middleton PG, Blyton DM, Sullivan CE. Sleep disordered breathing and pregnancy. Thorax. 2002; 57: 555–8.
   PubMed Web of Science ®Google Scholar
• Blyton DM, Skilton MR, Edwards N, Hennessy A, Celermajer DS, Sullivan CE. Treatment of sleep disordered breathing reverses low fetal activity levels in preeclampsia. Sleep. 2013; 36: 15–21.
   PubMed Web of Science ®Google Scholar
• Sforza E, Saint MM, Barthelemy JC, Roche F. Mood disorders in healthy elderly with obstructive sleep apnea: a gender effect. Sleep Med. 2016; 19: 57–62.
   PubMed Web of Science ®Google Scholar
• Campos-Rodriguez F, Queipo-Corona C, Carmona-Bernal C, Jurado-Gamez B, Cordero-Guevara J, Reyes-Nunez N, etal. Continuous positive airway pressure improves quality of life in women with OSA. A randomized-controlled trial. Am J Respir Crit Care Med. 2016. [Epub ahead of print]
   Google Scholar
• Engleman HM, Kingshott RN, Wraith PK, Mackay TW, Deary IJ, Douglas NJ. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med. 1999; 159: 461–7.
   PubMed Web of Science ®Google Scholar
• Myllylä M, Kurki S, Anttalainen U, Saaresranta T, Laitinen T. High adherence to CPAP treatment does not prevent the continuation of weight gain among severely obese OSAS patients. J Clin Sleep Med. 2015; 12: 519–28.
   Web of Science ®Google Scholar
• Montserrat JM, Ballester E, Olivi H, Reolid A, Lloberes P, Morello A, etal. Time-course of stepwise CPAP titration. Behavior of respiratory and neurological variables. Am J Respir Crit Care Med. 1995; 152: 1854–9.
   Web of Science ®Google Scholar
• Ayappa I, Norman RG, Hosselet JJ, Gruenke RA, Walsleben JA, Rapoport DM. Relative occurrence of flow limitation and snoring during continuous positive airway pressure titration. Chest. 1998; 114: 685–90.
   Web of Science ®Google Scholar
• Arora N, Meskill G, Guilleminault C. The role of flow limitation as an important diagnostic tool and clinical finding in mild sleep-disordered breathing. Sleep Sci. 2015; 8: 134–42.
   Web of Science ®Google Scholar
• McArdle N, King S, Shepherd K, Baker V, Ramanan D, Ketheeswaran S, etal. Study of a novel APAP algorithm for the treatment of obstructive sleep apnea in women. Sleep. 2015; 38: 1775–81.
   Web of Science ®Google Scholar
• Guilleminault C, Stoohs R, Kim YD, Chervin R, Black J, Clerk A. Upper airway sleep-disordered breathing in women. Ann Intern Med. 1995; 122: 493–501.
   PubMed Web of Science ®Google Scholar
• Sjösten N, Vahtera J, Salo P, Oksanen T, Saaresranta T, Virtanen M, etal. Increased risk of lost workdays prior to the diagnosis of sleep apnea. Chest. 2009; 136: 130–6.
   Web of Science ®Google Scholar
• Sjösten N, Kivimaki M, Oksanen T, Salo P, Saaresranta T, Virtanen M, etal. Obstructive sleep apnoea syndrome as a predictor of work disability. Respir Med. 2009; 103: 1047–55.
   Web of Science ®Google Scholar