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J Appl Physiol 85: 860-866, 1998;
8750-7587/98 $5.00
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Vol. 85, Issue 3, 860-866, September 1998

Heavy snoring with upper airway resistance syndrome may induce intrinsic positive end-expiratory pressure

Frédéric Lofaso, Anne Marie Lorino, Redouane Fodil, Marie Pia D'Ortho, Daniel Isabey, Hubert Lorino, Françoise Goldenberg, and Alain Harf

Service de Physiologie-Explorations Fonctionnelles, Institut National de la Santé et de la Recherche Médicale U 492, Hôpital Henri Mondor, 94010 Créteil, France

We studied eight heavy snorers with upper airway resistance syndrome to investigate potential effects of sleep on expiratory airway and lung resistance, intrinsic positive end-expiratory pressure, hyperinflation, and elastic inspiratory work of breathing (WOB). Wakefulness and non-rapid-eye-movement sleep with high- and with low-resistance inspiratory effort (H-RIE and L-RIE, respectively) were compared. No differences in breathing pattern were seen across the three conditions. In contrast, we found increases in expiratory airway and lung resistance during H-RIE compared with L-RIE and wakefulness (56 ± 24, 16 ± 4, and 11 ± 4 cmH2O · l-1 · s, respectively), with attendant increases in intrinsic positive end-expiratory pressure (5.4 ± 1.8, 1.4 ± 0.5, and 1.3 ± 1.3 cmH2O, respectively) and elastic WOB (6.1 ± 2.2, 3.7 ± 1.2, and 3.4 ± 0.7 J/min, respectively). The increase in WOB during H-RIE is partly caused by the effects of dynamic pulmonary hyperinflation produced by the increased expiratory resistance. Contrary to the Starling model, a multiple-element compliance model that takes into account the heterogeneity of the pharynx may explain flow limitation during expiration.

expiratory resistance; pulmonary hyperinflation


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