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. 2022 May 13;10(5):902.
doi: 10.3390/healthcare10050902.

Respiratory Arousals in Patients with Very Severe Obstructive Sleep Apnea and How They Change after a Non-Framework Surgery

Ethan I Huang  1   2   3 , Shu-Yi Huang  2   4   5 , Yu-Ching Lin  2   3   4   6 , Chieh-Mo Lin  4   7 , Chin-Kuo Lin  4   7 , Chia-Yu Hsu  8 , Ying-Chih Huang  8 , Jian-An Su  9
Affiliations

Respiratory Arousals in Patients with Very Severe Obstructive Sleep Apnea and How They Change after a Non-Framework Surgery

Ethan I Huang et al. Healthcare (Basel). .

Abstract

Respiratory arousal is the change from a state of sleep to a state of wakefulness following an apnea or hypopnea. In patients with obstructive sleep apnea (OSA), it could have a helpful role to activate upper airway muscles and the resumption of airflow and an opposing role to contribute to greater ventilatory instability, continue cycling, and likely exacerbate OSA. Patients with very severe OSA (apnea-hypopnea index (AHI) ≥ 60 events/h) may have specific chemical (e.g., possible awake hypercapnic hypoxemia) and mechanical (e.g., restricted dilator muscles) stimuli to initiate a respiratory arousal. Little was reported about how respiratory arousal presents in this distinct subgroup, how it relates to AHI, Epworth Sleepiness Scale (ESS), body mass index (BMI), and oxygen saturation, and how a non-framework surgery may change it. Here, in 27 patients with very severe OSA, we show respiratory arousal index was correlated with each of AHI, mean oxyhemoglobin saturation of pulse oximetry (SpO2), mean desaturation, and desaturation index, but not in BMI or ESS. The mean (53.5 events/h) was higher than other reports with less severe OSAs in the literature. The respiratory arousal index can be reduced by about half (45.3%) after a non-framework multilevel surgery in these patients.

Keywords: Continuous-Positive-Airway-Pressure (CPAP); one-stage; palatoplasty; polysomnography; retropharynx.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Scatter plot and correlation of respiratory arousal index vs. apnea-hypopnea index (AHI). It shows respiratory arousal index was positively related to AHI in the very severe OSA patients in this study. Preop: preoperative. h: hour.
Figure 2
Figure 2
Scatter plot and correlation of respiratory arousal index vs. Epworth Sleepiness Scale (ESS). It shows respiratory arousal index was not related to ESS in the very severe OSA patients in this study. Preop: preoperative. h: hour.
Figure 3
Figure 3
Scatter plot and correlation of respiratory arousal index vs. body mass index (BMI). It shows respiratory arousal index was not related to BMI in the very severe OSA patients in this study. Preop: preoperative. h: hour.
Figure 4
Figure 4
Scatter plot and correlation of respiratory arousal index vs. mean oxyhemoglobin saturation of pulse oximetry (SpO2). It shows respiratory arousal index was negatively related to mean SpO2 in the very severe OSA patients in this study. Preop: preoperative. h: hour.
Figure 5
Figure 5
Scatter plot and correlation of respiratory arousal index vs. mean desaturation. It shows respiratory arousal index was positively related to mean desaturation in the very severe OSA patients in this study. Preop: preoperative. h: hour.
Figure 6
Figure 6
Scatter plot and correlation of respiratory arousal index vs. desaturation index. It shows respiratory arousal index was positively related to desaturation index the very severe OSA patients in this study. Preop: preoperative. h: hour.
Figure 7
Figure 7
Individual change of (a) respiratory arousal index and (b) total arousal index before and after the surgery. The surgery reduced both respiratory and total arousal indexes. h: hour.
See this image and copyright information in PMC

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