Upper airway walls impedance measured with head plethysmograph

Respiratory input impedance (Zrs) measured by forced oscillations needs to be corrected for the motion of extrathoracic airway walls. Two methods of obtaining the impedance of this shunt pathway [upper airway impedance (Zuaw)] were compared in six normal subjects. In the first, flow was measured at the airway opening during Valsalva maneuvers, as described by Michaelson et al. (10). In the second, motions of upper airway walls were directly assessed during respiratory impedance measurements by use of a head plethysmograph. Larger upper airway impedance values were found during Valsalva maneuvers, corresponding to a larger upper airway resistance (Ruaw) (at 20 Hz, Ruaw = 9.1 +/- 4.7 compared with 7.0 +/- 2.1 cmH2O X 1-1 X s with the second method) and inertance (Iuaw) (Iuaw = 0.053 +/- 0.036 vs. 0.025 +/- 0.008 cmH2O X 1-1 X s2, P less than 0.05) and a lower upper airway compliance (Cuaw) (Cuaw = 0.78 +/- 0.33 vs. 1.15 +/- 0.15 ml X cmH2O-1, P less than 0.05). Active contraction of facial muscles during Valsalva maneuvers may be responsible for this finding. As a consequence, respiratory impedance values are undercorrected when using the Valsalva method, leading in normal subjects to an overestimation of respiratory compliance by 30% and an underestimation of inertance by 16% (P less than 0.05) and promoting positive frequency dependence of respiratory resistance. Substantial errors may be avoided by using a head plethysmograph, which permits measuring Zrs and Zuaw simultaneously.