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Relationship between surface tension of upper airway lining liquid and upper airway collapsibility during sleep in obstructive sleep apnea hypopnea syndrome

Ludwig Engel Centre for Respiratory Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia 2145

Submitted 9 May 2003 ; accepted in final form 8 July 2003

Lowering surface tension () of upper airway lining liquid (UAL) reduces upper airway opening (anesthetized humans) and closing (anesthetized rabbits) pressures. We now hypothesize that in sleeping obstructive sleep apnea hypopnea syndrome (OSAHS) patients lowering of UAL will enhance upper airway stability and decrease the severity of sleep-disordered breathing. Nine OSAHS patients [respiratory disturbance index (RDI): 49 ± 8 (SE) events/h, diagnostic night] participated in a two-part, one-night, polysomnography study. In the first part, upper airway closing pressures (during non-rapid eye movement sleep, Pcrit) were measured and samples of UAL (awake) were obtained before and after 2.5 ml of surfactant (Exosurf, Glaxo Smith Kline) was instilled into the posterior pharynx. The of UAL was determined with the use of the "pull-off" force technique. In the second part, subjects received a second application of 2.5 ml of surfactant and then slept the remainder of the night (205 ± 30 min). Instillation of surfactant decreased the of UAL from 60.9 ± 3.1 mN/m (control) to 45.2 ± 2.5 mN/m (surfactant group) (n = 9, P < 0.001). Pcrit decreased from 1.19 ± 1.14 cmH₂O (control) to -0.56 ± 1.15 cmH₂O (surfactant group) (n = 7, P < 0.02). Compared with the second half of diagnostic night, surfactant decreased RDI from 51 ± 8 to 35 ± 8 events/h (n = 9, P < 0.03). The fall in RDI (RDI) correlated with the fall in of UAL () (RDI = 1.8 x , r = 0.68, P = 0.04). Hypopneas decreased 50% from 42 ± 8 to 20 ± 5 events/h (n = 9, P < 0.03, paired t-test). The of UAL measured the next morning remained low at 49.5 ± 2.7 mN/m (n = 9, P < 0.001, ANOVA, compared with control). In conclusion, instillation of surfactant reduced the of UAL in OSAHS patients and decreased Pcrit and the occurrence of hypopneas. Therapeutic manipulation of of UAL may be beneficial in reducing the severity of sleep-disordered breathing in OSAHS patients.

upper airway mechanics

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