A noninvasive technique for detecting obstructive and central sleep apnea.

A new noninvasive method to detect obstructive and central sleep apnea [(OSA) and (CSA)] events is described. Data were collected from ten volunteer subjects with a previous diagnosis of OSA while they were titrated for continuous positive airway pressure (CPAP) therapy. Apneic events were identify by analyzing of estimated airway impedance determined from pressure and airflow signals delivered from CPAP. To enhance performance of this technique, a single-frequency (5 Hz with 0.5 cmH2O peak-to-peak amplitude) probing signal was superimposed on the applied CPAP pressure. The results indicated that estimated airway impedance during OSA (mean: 17.9, SD: 3.4, N = 50) was significantly higher then during CSA (mean: 4.1, SD: 1.7, N = 50). When the estimated impedance of OSA and CSA events were compared to a fixed threshold, 100% of all events can be correctly categorized. These results indicate that it may be possible to diagnose OSA and CSA noninvasively based upon this technique. The instrument and the algorithm required are relatively simple and can be incorporated in a home-based device. If this method was used for prescreening apnea patients, it could reduce cost, waiting time, and discomfort associated with traditional diagnostic procedures.

Automatic control of airway pressure for treatment of obstructive sleep apnea.

Obstructive sleep apnea (OSA) occurs when airflow ceases because of pharyngeal wall collapse in sleep. Repeated apneic events results in the development of a pathological condition called OSA syndrome. We describe the methodology and design of a prosthetic device, named automatic positive airway pressure (APAP), for treatment of this syndrome. APAP applies a stream of air via a nasal mask at an initial pressure selected by the patient. By sensing specific pressure characteristics of air flow immediately preceding pharyngeal wall collapse, the APAP device automatically raises the applied pressure to maintain a patent upper airway and thus prevent apnea. Conversely, when such conditions are absent, pressure is lowered step wise until a preselected minimum pressure is reached. Performance evaluation of the APAP system in five OSA patients and five normal (asymptomatic for sleep apnea) subjects revealed that it effectively treated OSA syndrome. It lowered the apnea-hypopnea index without disturbing sleep and resulted in a lower mean airway pressure compared to the traditional continuous positive airway pressure (CPAP) therapy. The results also show that the pressure needed to prevent OSA varied significantly throughout the night. For OSA syndrome patients, this pressure ranged from 3 to 18 cm H2O. The mean airway pressure for these patients had a sample average of 6.80 cm H2O and a standard deviation of 3.17 cm H2O. In normal subjects, the device did not raise pressure except in response to Pharyngeal Wall Vibration events.

Analysis of the pressure-volume relationship of excised lungs.

The pressure-volume relationship of excised lungs is explicitly defined in the form of a mathematical model. In the model, lung volume (V) is given by the function V = VmaxF(Ptp,T*)H(Ptp). Vmax is maximum lung volume. F, which describes the recruitment of air-filled units, is a function of transpulmonary pressure (Ptp) and surface tension (T*), whereas H, which is also a function of transpulmonary pressure, describes the expansion of recruited units against tissue forces. F is shown to be the integral of the normalized distribution function of the lung units and remains constant so long as the number of air-filled units does not change. H, on the other hand, is shown to be the product of the elastic properties of the tissues and is responsible for the characteristic non-linear sigmoid shape of lung deflation curves. Results obtained with the model are consistent with the hypothesis that tissue elasticity, tissue hysteresis, area dependent surface tension, and recruitment share responsibility for the characteristic hysteresis of excised lungs.