Minerva Medica 2021 Apr 29

DOI: 10.23736/S0026-4806.21.07299-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Determinants of response to hypercapnia and to progressive and transient hypoxia in obstructive sleep apnea patients

Giuseppe M. CORBO ¹, Alessandro DI MARCO BERARDINO ² ✉, Antonina RE ², Dina VISCA ¹, Giuliana PASCIUTO ¹, Bruno IOVENE ¹, Flaminio MORMILE ¹, Salvatore VALENTE ¹

¹ UOC di Pneumologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; ² SOD di Pneumologia, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Ancona, Italy

BACKGROUND: The knowledge regarding the control of breathing during wakefulness in patients affected by obstructive sleep apnoea (OSAS) is still challenging. The aim of this study is firstly to analyse hypoxic and hypercapnic ventilatory response in OSA patients in comparison to controls and secondly, to investigate correlations between chemosensivity and both lung function tests, such as arterial blood gas analysis and spirometric parameters, and clinical characteristics, such as age and BMI.
METHODS: 17 never treated OSA patients (16M; 53±13.2 yrs; BMI= 34.5±8.1; AHI =45 ±14.7) underwent nocturnal cardiopulmonary monitoring test, complete lung function tests (spirometry , lung volumes and arterial blood gas analysis on room air). Read’s rebreathing test was used to evaluate hypercapnic ventilatory response (HVRCO2); hypoxic ventilatory response (HVRO2) was studied through progressive and transient methods. The response was expressed in terms of slope of linear regression for HVRCO2 and of hyperbolic curve for HVRO2 between minute ventilation (VE) or mean inspiratory flow (VT/Ti) and PetCO2 or PetO2.
RESULTS: the OSA group showed increased transient, but not progressive, HVRO2 and a lower HVRCO2. A lower HVRCO2 was predicted by greater values of BMI (p<0.01). Progressive HVRO2 increased with age and lower FEV1/VC, while transient HVRO2 (p<0.05) was inversely correlated with the nocturnal lowest SaO2 (p<0.01).
CONCLUSIONS: Nocturnal intermittent hypoxic stimuli increases daytime glomic reactivity to transient hypoxia, while BMI is the main independent determinants of the bulbar response to hypercapnia in normocapnic OSAS patients.

KEY WORDS: Breathing control; Sleep apnoea; Ventilation; Chemoreceptors