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Articles in PresS, published online ahead of print September 6, 2002
J Appl Physiol, 10.1152/jap.00216.2002
Submitted on March 14, 2002
Accepted on August 12, 2002
1 Centre de recherche, Hopital Laval, Institut universitaire de cardiologie et de pneumologie de l'Universite Laval, Quebec, Quebec, Canada; UPRES, Universite Paris VI Pierre Marie Curie, Paris, France; Service de Physiologie, Centre Hospitalier Universitaire de Rouen, Rouen, France
2 UPRES, Universite Paris VI Pierre Marie Curie, Paris, France; Laboratoire de Physiopathologie Respiratoire, Service de Pneumologie, Groupe Hospitalier Pitie-SalpItriere, Hopitaux de Paris-Assistance Publique, Paris, France
3 UPRES, Universite Paris VI Pierre Marie Curie, Paris, France; Laboratoire de Physiopathologie Respiratoire, Service de Pneumologie, Groupe Hospitalier Pitie-SalpItriere, Hopitaux de Paris-Assistance Publique, Paris, France; Service de Medecine Interne, Groupe Hospitalier Pitie-Salpetriere, Hopitaux de Paris-Assistance Publique, Paris, France
4 Centre de recherche, Hopital Laval, Institut universitaire de cardiologie et de pneumologie de l'Universite Laval, Quebec, Quebec, Canada; UPRES, Universite Paris VI Pierre Marie Curie, Paris, France
* To whom correspondence should be addressed. E-mail: frederic.series{at}med.ulaval.ca.
The diagnosis of the obstructive sleep apnea syndrome relies on polysomnography (PSG). Bilateral anterior magnetic phrenic stimulation (BAMPS) mimics the dissociation between upper airway (UA) muscles and diaphragm commands that leads to UA closure during sleep. We evaluated BAMPS as a means identify OSAS patients through the characterization of the UA dynamics in 28 consecutive awake patients (18 apneic and 10 non apneic). Driving pressure (Pd) and instantaneous flow (V') were recorded in response to BAMPS to determine the point of flow limitation (V'Imax, Pd,lim) and of minimal flow (V'Imin, Pd,peak) and the flow-pressure relationship (V'I=k1*Pd -k2*Pd2). V'Imax, V'Imin, RuaV'Imin and k1 were correlated with AHI (respectively, R=-0.735, p<0.0001; R=-0.584, p=0.001; R=0.474, p=0.01 and R=-0.567, p<0.01). BMI was also correlated with AHI (R=0.500, p<0.01). Apneic patients had a lower V'Imax (V'Imax = 678±386 ml. s-1 vs 1247±271 ml. s-1 ; p< 0.001), a lower V'Imin (V'Imin = 460±313 ml. s-1 vs 822±393 ml. s-1 ; p<0.05) and a lower k1 (k1 = 162±67 vs 272 ± 112 ml.cmH2O.s-1 ; p<0.01) than non apneic ones. Using a classification and regression tree approach, we found that a V'Imax <803 ml.s-1 (n = 12) selected only apneic patients. When V'Imax was >803 ml.s-1 (n = 16), a k1 >266.7 ml.cmH2O.s-1 identified only non-apneic patients (n = 5). In 11 cases, V'Imax was > 803 ml.s-1 and k1 < 266.7 ml.cmH2O.s-1. These included 5 non apneic and 6 apneic patients. We conclude that UA dynamic properties studied with BAMPS during wakefulness significantly differ between non apneic and apneic patients.
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