TY - JOUR
T1 - Dynamic behaviour of the soft palate during nasal positive pressure ventilation under anaesthesia and paralysis
T2 - comparison between patients with and without obstructive sleep-disordered breathing
AU - Okuyama, M.
AU - Kato, S.
AU - Sato, S.
AU - Okazaki, J.
AU - Kitamura, Y.
AU - Ishikawa, T.
AU - Sato, Y.
AU - Isono, S.
N1 - Funding Information:
Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan Grants-in-Aid for Scientific Research (Kakenhi), Grants-in-Aids for Young Scientists B no. 26861223).
Publisher Copyright:
© 2017
PY - 2018/1
Y1 - 2018/1
N2 - Background: Difficult mask ventilation is common and is known to be associated with sleep-disordered breathing (SDB). It is our hypothesis that the incidence of expiratory retropalatal (RP) airway closure (primary outcome) during nasal positive pressure ventilation (PPV) is more frequent in patients with SDB (apnea hypopnea index ≥5 h−1) than non-SDB subjects. Methods: The severity of SDB was assessed before surgery using a portable sleep monitor. In anaesthetized and paralysed patients with (n=11) and without SDB (n=9), we observed the behaviour of the RP airway endoscopically during nasal PPV with the mouth closed and determined the dynamic RP closing pressure, which was defined as the highest airway pressure above which the RP airway closure was reversed. The static RP closing pressure was obtained during cessation of mechanical ventilation in patients with dynamic RP closure during nasal PPV. Results: The expiratory RP airway closure accompanied by expiratory flow limitation occurred more frequently in SDB patients (9/11, 82%) than in non-SDB subjects (2/9, 22%; exact logistic regression analysis: P=0.022, odds ratio 3.6, 95% confidence interval 1.1–15.4). Receiver operating characteristic curve analyses indicated AHI >10h−1 and presence of habitual snoring as clinically useful predictors for the occurrence of RP closure during PPV. Dynamic RP closing pressure was greater than the static RP closing pressure by approximately 4–5 cm H2O. Conclusions: Valve-like dynamic RP closure that limits expiratory flow during nasal PPV occurs more frequently in SDB patients.
AB - Background: Difficult mask ventilation is common and is known to be associated with sleep-disordered breathing (SDB). It is our hypothesis that the incidence of expiratory retropalatal (RP) airway closure (primary outcome) during nasal positive pressure ventilation (PPV) is more frequent in patients with SDB (apnea hypopnea index ≥5 h−1) than non-SDB subjects. Methods: The severity of SDB was assessed before surgery using a portable sleep monitor. In anaesthetized and paralysed patients with (n=11) and without SDB (n=9), we observed the behaviour of the RP airway endoscopically during nasal PPV with the mouth closed and determined the dynamic RP closing pressure, which was defined as the highest airway pressure above which the RP airway closure was reversed. The static RP closing pressure was obtained during cessation of mechanical ventilation in patients with dynamic RP closure during nasal PPV. Results: The expiratory RP airway closure accompanied by expiratory flow limitation occurred more frequently in SDB patients (9/11, 82%) than in non-SDB subjects (2/9, 22%; exact logistic regression analysis: P=0.022, odds ratio 3.6, 95% confidence interval 1.1–15.4). Receiver operating characteristic curve analyses indicated AHI >10h−1 and presence of habitual snoring as clinically useful predictors for the occurrence of RP closure during PPV. Dynamic RP closing pressure was greater than the static RP closing pressure by approximately 4–5 cm H2O. Conclusions: Valve-like dynamic RP closure that limits expiratory flow during nasal PPV occurs more frequently in SDB patients.
KW - airway obstruction
KW - anaesthesia
KW - pharynx
KW - sleep apnoea syndromes
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U2 - 10.1016/j.bja.2017.11.016
DO - 10.1016/j.bja.2017.11.016
M3 - Article
C2 - 29397128
AN - SCOPUS:85047427026
VL - 120
SP - 181
EP - 187
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
SN - 0007-0912
IS - 1
ER -