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Phenotyping Pharyngeal Pathophysiology using Polysomnography in Patients with Obstructive Sleep Apnea
Scott A Sands1,2,3, Bradley A Edwards1,4,5, Philip I Terrill6
11 Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
American Journal of Respiratory and Critical Care Medicine
|January 13, 2018
Summary
This study developed a noninvasive method to measure key obstructive sleep apnea (OSA) traits during sleep. This approach allows for personalized OSA therapies based on individual patient phenotypes.
Area of Science:
- Sleep Medicine
- Respiratory Physiology
- Medical Diagnostics
Background:
- Obstructive sleep apnea (OSA) therapies could be improved by tailoring treatments to individual patient phenotypes.
- A clinically applicable method is needed to quantify key contributors to OSA, such as pharyngeal collapsibility and compensatory muscle responsiveness.
Purpose of the Study:
- To develop and validate a noninvasive method for quantifying pharyngeal collapsibility and compensatory muscle responsiveness during diagnostic polysomnography.
- To enable phenotyping of OSA based on physiological traits without specialized interventions.
Main Methods:
- A novel automated, noninvasive method was developed to estimate ventilatory drive during polysomnography.
- Pharyngeal collapsibility and compensatory muscle responsiveness were quantified in 29 OSA patients using this method.
- Comparisons were made against gold standard measures including intraesophageal diaphragm EMG and continuous positive airway pressure (CPAP) manipulation.
- The validity of using nasal pressure as a surrogate for ventilation was also assessed in 11 patients.
Main Results:
- Polysomnography-derived estimates of collapsibility and compensation showed favorable correlations with gold standard measures (R=0.83 and R=0.76, respectively, P<0.0001).
- The method effectively stratified patients into high and low trait subgroups with 69-86% accuracy compared to ventilatory drive measures (P<0.05).
- Nasal pressure demonstrated high agreement with pneumotach for trait estimation (R≥0.98, P<0.001).
Conclusions:
- Phenotypes of pharyngeal dysfunction in OSA can be identified noninvasively during sleep by analyzing spontaneous changes in ventilation and ventilatory drive.
- This approach holds promise for facilitating precision therapeutic interventions for obstructive sleep apnea.
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