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Clinica di Semeiotica Medica, University of Ancona, 60020 Ancona, Italy; Laboratoire de Physio-Pathologie Respiratoire et Service de Explorations Fonctionnelles, Groupe Hospitalier Pitié-Salpêtrière, University of Paris VI, Paris, Cedex 13, France; Divisione di Pneumologia, Ospedale Sant'Orsola-Malpighi, 40100 Bologna, Italy; and Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada H2Z 2P2
In spontaneously
breathing subjects, intrathoracic expiratory flow limitation can be
detected by applying a negative expiratory pressure (NEP) at the mouth
during tidal expiration. To assess whether NEP might
increase upper airway resistance per se, the interrupter resistance of
the respiratory system (Rint,rs) was computed with and without NEP by
using the flow interruption technique in 12 awake healthy subjects, 6 nonsnorers (NS), and 6 nonapneic snorers (S). Expiratory flow
(
) and Rint,rs were measured under control
conditions with increased voluntarily and during
random application of brief (0.2-s) NEP pulses from 
1 to
7 cmH2O, in both the seated
and supine position. In NS, Rint,rs with spontaneous increase in
and with NEP was similar [3.10 ± 0.19 and 3.30 ± 0.18 cmH2O · l
1 · s
at spontaneous of 1.0 ± 0.01 l/s and at
of 1.1 ± 0.07 l/s with NEP (5
cmH2O), respectively]. In S,
a marked increase in Rint,rs was found at all levels of NEP
(P < 0.05). Rint,rs was 3.50 ± 0.44 and 8.97 ± 3.16 cmH2O · l1 · s
at spontaneous of 0.81 ± 0.02 l/s and at
of 0.80 ± 0.17 l/s with NEP (5
cmH2O), respectively
(P < 0.05). With NEP, Rint,rs was
markedly higher in S than in NS both seated
(F = 8.77; P < 0.01) and supine
(F = 9.43;
P < 0.01). In S,
increased much less with NEP than in NS and was
sometimes lower than without NEP, especially in the supine position.
This study indicates that during wakefulness nonapneic S have more
collapsible upper airways than do NS, as reflected by the marked
increase in Rint,rs with NEP. The latter leads occasionally to an
actual decrease in such as to invalidate the NEP
method for detection of intrathoracic expiratory flow limitation.
upper airway collapsibility; body position; resting breathing; snoring
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