High-flow transtracheal insufflation treats obstructive sleep apnea - A pilot study

Schneider, H O'Hearn, DJ Leblanc, K Smith, PL O'Donnell, CP Eisele, DW Peter, JH Schwartz, AR

H. Schneider et al., High-flow transtracheal insufflation treats obstructive sleep apnea - A pilot study, AM J R CRIT, 161(6), 2000, pp. 1869-1876

32

INGLESE

Article

Cardiovascular & Respiratory Systems","da verificare

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE

1073-449X → ACNP

161

6

2000

1869 - 1876

ISI

1073-449X(200006)161:6<1869:HTITOS>2.0.ZU;2-7

To determine the effect of transtracheal insufflation (TTI) on obstructive sleep apnea (OSA), we examined breathing patterns in five tracheostomized p atients with OSA at varying TTI flow rates when breathing with a closed tra cheostomy. The breathing patterns and polysomnographic responses to air ins ufflation were studied as TTI was increased from 0 to 15 L/min for brief pe riods of non-rapid eye movement (NREM) steep (Experiment I). The frequency of sleep-disordered breathing episodes remained high at 0 and 5 L/min (87.0 +/- 33.7 and 79.4 +/- 24.4 episodes per hour NREM) and decreased significa ntly to 41.3 +/- 31.5 and 43.4 +/- 31.4 episodes/h NREM sleep at rates of 1 0 and 15 L/min, respectively (p = 0.003). At high levels of TTI (10 and 15 L/min), obstructive apneas and hypopneas decreased but periodic laryngeal o bstructions were induced during stage 1 NREM sleep. To prevent laryngeal ob structions, a servo-control system was used to briefly interrupt Tn during these events. When this system was implemented for more prolonged periods o f sleep (Experiment 2, total sleep time 176.6 +/- 12.5 min), high-flow TTI (hf-TTI, 15 L/min) led to an overall reduction in the combined frequency of obstructive apneas and laryngeal obstructions from 63.8 +/- 21.8 to 10.7 /- 9.1 (p < 0.03) and was associated with a marked reduction in arousal fre quency from 60.0 +/- 26.0 to 8.3 +/- 5.4/h in NREM sleep, and from 67.5 +/- 3.5 to 0 +/- 0/h in rapid eye movement (REM) sleep. Our findings demonstra te that hf-TTI stabilized breathing patterns in apneic patients, and was sa fe and efficacious for prolonged periods of sleep.