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Articles in PresS, published online ahead of print May 31, 2002
J Appl Physiol, 10.1152/jap.01140.2001
Submitted on November 16, 2001
Accepted on May 28, 2002
1 Sleep Research Laboratory, John D. Dingell VA Medical Center, Detroit, MI, USA; Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
2 Sleep Research Laboratory, John D. Dingell VA Medical Center, Detroit, MI, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University, Detroit, MI, USA
3 Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
4 Sleep Research Laboratory, John D. Dingell VA Medical Center, Detroit, MI, USA
* To whom correspondence should be addressed. E-mail: jrowley{at}intmed.wayne.edu.
The physiologic significance of inspiratory flow limitation (IFL) has recently been recognized but methods of detecting IFL can be subjective. We sought to develop a mathematical model of the upper airway pressure-flow relationship that would objectively detect flow-limitation. We present a theoretical discussion that predicts that a polynomial function, F(P) = AP3 + BP2 + CP + D, where F(P) is flow and P is supraglottic pressure, best characterizes the pressure-flow relationship and allows for the objective detection of IFL. In Protocol #1, Step #1, we performed curve-fitting of the pressure-flow relationship of 20 breaths to 5 mathematical functions and found that highest correlation coefficients (R2) for quadratic (0.88±0.10) and polynomial (0.91±0.05, p<0.05 for both compared to the other functions) functions. In Step #2, we performed error-fit calculations on 50 breaths comparing the quadratic and polynomial functions and found that the error fit was lowest for the polynomial function (3.3±0.06% v. 21.1±19.0%, p<0.001). In Protocol #2, we performed sensitivity/specificity analysis on 2 sets of breaths (50 and 544 breaths) comparing the mathematical determination of IFL to manual determination. Mathematical determination of IFL had high sensitivity, specificity and positive predictive value (>99% for each). We conclude that a polynomial function can be used to predict the relationship between pressure and flow in the upper airway and objectively determine the presence of IFL.
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