Journal article
Comparison of Collapsibility of the Human Upper Airway During Anesthesia and During Sleep
Anesthesia and analgesia, Vol.130(4), pp.1008-1017
2020
PMID: 30896596
Abstract
BACKGROUND:
The propensities for the upper airway to collapse during anesthesia and sleep are related, although much of our understanding of this relationship has been inferred from clinical observation and indirect measures such as the apnea–hypopnea index. The aim of this study was to use an identical, rigorous, direct measure of upper airway collapsibility (critical closing pressure of the upper airway) under both conditions to allow the magnitude of upper airway collapsibility in each state to be precisely compared.
METHODS:
Ten subjects (8 men and 2 women; mean ± SD: age, 40.4 ± 12.1 years; body mass index, 28.5 ± 4.0 kg/m2) were studied. Critical closing pressure of the upper airway was measured in each subject on separate days during (1) propofol anesthesia and (2) sleep.
RESULTS:
Critical closing pressure of the upper airway measurements were obtained in all 10 subjects during nonrapid eye movement sleep and, in 4 of these 10 subjects, also during rapid eye movement sleep. Critical closing pressure of the upper airway during anesthesia was linearly related to critical closing pressure of the upper airway during nonrapid eye movement sleep (r = 0.64 [95% CI, 0.02–0.91]; n = 10; P = .046) with a similar tendency in rapid eye movement sleep (r = 0.80 [95% CI, −0.70 to 0.99]; n = 4; P = .200). However, critical closing pressure of the upper airway during anesthesia was systematically greater (indicating increased collapsibility) than during nonrapid eye movement sleep (2.1 ± 2.2 vs −2.0 ± 3.2 cm H2O, respectively, n = 10; within-subject mean difference, 4.1 cm H2O [95% CI, 2.32–5.87]; P < .001) with a similar tendency during rapid eye movement sleep (1.6 ± 2.4 vs −1.9 ± 4.3 cm H2O, respectively, n = 4; unadjusted difference, 3.5 cm H2O [95% CI, −0.95 to 7.96]; P = .087).
CONCLUSIONS:
These results demonstrate that the magnitude of upper airway collapsibility during anesthesia and sleep is directly related. However, the upper airway is systematically more collapsible during anesthesia than sleep, suggesting greater vulnerability to upper airway obstruction in the anesthetized state.
Details
- Title
- Comparison of Collapsibility of the Human Upper Airway During Anesthesia and During Sleep
- Authors/Creators
- Kathleen J Maddison - The University of Western AustraliaJennifer H Walsh - Sir Charles Gairdner HospitalKelly L Shepherd - West Australian Sleep Disorders Research InstituteChrianna Bharat - Departments of ResearchBradley K Lawther - Sir Charles Gairdner HospitalPeter R Platt - Sir Charles Gairdner HospitalPeter R Eastwood - West Australian Sleep Disorders Research InstituteDavid R Hillman - West Australian Sleep Disorders Research Institute
- Publication Details
- Anesthesia and analgesia, Vol.130(4), pp.1008-1017
- Identifiers
- 991005592646207891
- Copyright
- © 2019 International Anesthesia Research Society
- Murdoch Affiliation
- Vice Chancellery
- Language
- English
- Resource Type
- Journal article
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- Citation topics
- 1 Clinical & Life Sciences
- 1.137 Sleep Science & Circadian Systems
- 1.137.382 Obstructive Sleep Apnea
- Web Of Science research areas
- Anesthesiology
- ESI research areas
- Clinical Medicine