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Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure

Title: Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure
Authors: Carlisle, T
Ward, NR
Atalla, A
Cowie, MR
Simonds, AK
Morrell, MJ
Item Type: Journal Article
Abstract: The increased prevalence of obstructive sleep apnea (OSA) in congestive heart failure (CHF) may be associated with rostral fluid shift. We investigated the effect of overnight rostral fluid shift on pharyngeal collapsibility (Pcrit), pharyngeal caliber (APmean), and apnea‐hypopnea index (AHI) in CHF patients. Twenty‐three optimally treated systolic CHF patients were studied. Neck circumference was measured immediately prior to sleep in the evening and immediately after waking in the morning as a marker of rostral fluid shift. Pcrit was measured during sleep, early and late in the night. APmean was measured using acoustic reflection at the same times as neck circumference measurements. 15/23 CHF patients experienced an overnight increase in neck circumference; overall neck circumference significantly increased overnight (mean±SD, evening: 41.7 ± 3.2 cm; morning: 42.3 ± 3.1 cm; P = 0.03). Pcrit increased significantly overnight (early‐night: −3.8 ± 3.3 cmH2O; late‐night: −2.6 ± 3.0 cmH2O; P = 0.03) and APmean decreased (evening: 4.2 ± 1.3 cm2; morning: 3.7 ± 1.3 cm2; P = 0.006). The total AHI correlated with neck circumference (r = 0.4; P = 0.04) and Pcrit (r = 0.5; P = 0.01). APmean correlated with neck circumference (r = −0.47; P = 0.02). There was no significant change in AHI between the first and second half of the night (first‐half: 12.9 ± 12.4/h; second‐half: 13.7 ± 13.3/h; P = 0.6). Overnight rostral fluid shift was associated with increased pharyngeal collapsibility and decreased pharyngeal caliber during sleep in CHF patients. Rostral fluid shift may be an important mechanism of OSA in this patient group.
Issue Date: 4-Jan-2017
Date of Acceptance: 12-Aug-2016
URI: http://hdl.handle.net/10044/1/49927
DOI: https://dx.doi.org/10.14814/phy2.12956
ISSN: 2051-817X
Publisher: Wiley
Journal / Book Title: Physiological Reports
Volume: 5
Issue: 1
Copyright Statement: © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Imperial College Trust
Royal Brompton & Harefield NHS Foundation Trust
National Institute for Health Research
National Institute for Health Research
Royal Brompton & Harefield NHS Foundation Trust
Funder's Grant Number: N/A
Cost Centre 6018
08/56/02
BRU 6279
6059
Keywords: Science & Technology
Life Sciences & Biomedicine
Physiology
Heart failure
obstructive sleep apnea
pcrit
pharyngeal collapsibility
rostral fluid shift
BODY POSITIVE-PRESSURE
HEALTHY-SUBJECTS
PHARYNGEAL RESISTANCE
PREVALENCE
MEN
SEVERITY
WOMEN
WAKEFULNESS
DYSFUNCTION
ADULTS
Publication Status: Published
Article Number: ARTN e12956
Appears in Collections:National Heart and Lung Institute
Airway Disease
Faculty of Medicine



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