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

Publisher: published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society Country of Publication: United States NLM ID: 101607800 Publication Model: Print Cited Medium: Internet ISSN: 2051-817X (Electronic) Linking ISSN: 2051817X NLM ISO Abbreviation: Physiol Rep Subsets: MEDLINE

Original Publication: [Malden MA] : published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society, 2013-

Airway Obstruction/*physiopathology ; Fluid Shifts/*physiology ; Heart Failure/*physiopathology ; Sleep Apnea, Obstructive/*physiopathology; Heart Failure/complications ; Neck/anatomy & histology ; Pharynx/physiopathology ; Sleep/physiology ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/epidemiology ; Aged ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Prevalence

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.
(© 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.)

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08/56/02 United Kingdom DH_ Department of Health

Keywords: Heart failure; obstructive sleep apnea; pcrit; pharyngeal collapsibility; rostral fluid shift

Date Created: 20170107 Date Completed: 20171106 Latest Revision: 20250530

20260130

PMC5256151

10.14814/phy2.12956

28057850