Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1996 Feb;51(2):190–192. doi: 10.1136/thx.51.2.190

Effect of chronic continuous positive airway pressure (CPAP) therapy on upper airway size in patients with sleep apnoea/hypopnoea syndrome.

I L Mortimore 1, P Kochhar 1, N J Douglas 1
PMCID: PMC473036  PMID: 8711654

Abstract

BACKGROUND: There is evidence to suggest that chronic continuous positive airway pressure (CPAP) therapy may produce reversible changes in upper airway morphology and function in patients with sleep apnoea/hypopnoea. This study was designed to examine the effect of chronic CPAP therapy on upper airway calibre. METHODS: Twenty four men with the sleep apnoea/hypopnoea syndrome (mean (SE) apnoea/hypopnoea index 37 (5)) underwent lateral cephalometry with measurement of posterior airway space performed before and at least three months after initiation of CPAP therapy. RESULTS: There was no weight change between the two assessments and mean CPAP use was 4.8 (0.4) hours per night. Posterior airway space (PAS) was measured in erect and supine postures. PAS supine increased with CPAP therapy from a mean (SE) of 11.8 (0.8) mm to 13.4 (0.8) mm, but PAS erect did not. Correlation of the change in PAS (dPAS) before and after CPAP therapy showed an increase with increasing CPAP compliance measured as machine run time both for dPAS supine (r = 0.68) and dPAS erect (r = 0.47). CONCLUSIONS: Patients with the sleep apnoea/hypopnoea syndrome regularly using CPAP for more than four hours per night all showed an increase in dPAS supine. The use of chronic CPAP increases PAS supine probably by a reduction in upper airway oedema, and the change in size is dependent on CPAP use.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alex C. G., Aronson R. M., Onal E., Lopata M. Effects of continuous positive airway pressure on upper airway and respiratory muscle activity. J Appl Physiol (1985) 1987 May;62(5):2026–2030. doi: 10.1152/jappl.1987.62.5.2026. [DOI] [PubMed] [Google Scholar]
  2. Anch A. M., Remmers J. E., Bunce H., 3rd Supraglottic airway resistance in normal subjects and patients with occlusive sleep apnea. J Appl Physiol Respir Environ Exerc Physiol. 1982 Nov;53(5):1158–1163. doi: 10.1152/jappl.1982.53.5.1158. [DOI] [PubMed] [Google Scholar]
  3. Cartwright R. D. Effect of sleep position on sleep apnea severity. Sleep. 1984;7(2):110–114. doi: 10.1093/sleep/7.2.110. [DOI] [PubMed] [Google Scholar]
  4. Collop N. A., Block A. J., Hellard D. The effect of nightly nasal CPAP treatment on underlying obstructive sleep apnea and pharyngeal size. Chest. 1991 Apr;99(4):855–860. doi: 10.1378/chest.99.4.855. [DOI] [PubMed] [Google Scholar]
  5. Douglas N. J., Jan M. A., Yildirim N., Warren P. M., Drummond G. B. Effect of posture and breathing route on genioglossal electromyogram activity in normal subjects and in patients with the sleep apnea/hypopnea syndrome. Am Rev Respir Dis. 1993 Nov;148(5):1341–1345. doi: 10.1164/ajrccm/148.5.1341. [DOI] [PubMed] [Google Scholar]
  6. Engleman H. M., Martin S. E., Douglas N. J. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax. 1994 Mar;49(3):263–266. doi: 10.1136/thx.49.3.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hudgel D. W. Variable site of airway narrowing among obstructive sleep apnea patients. J Appl Physiol (1985) 1986 Oct;61(4):1403–1409. doi: 10.1152/jappl.1986.61.4.1403. [DOI] [PubMed] [Google Scholar]
  8. Kribbs N. B., Pack A. I., Kline L. R., Getsy J. E., Schuett J. S., Henry J. N., Maislin G., Dinges D. F. Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis. 1993 May;147(5):1162–1168. doi: 10.1164/ajrccm/147.5.1162. [DOI] [PubMed] [Google Scholar]
  9. Leiter J. C., Knuth S. L., Bartlett D., Jr The effect of sleep deprivation on activity of the genioglossus muscle. Am Rev Respir Dis. 1985 Dec;132(6):1242–1245. doi: 10.1164/arrd.1985.132.6.1242. [DOI] [PubMed] [Google Scholar]
  10. McEvoy R. D., Sharp D. J., Thornton A. T. The effects of posture on obstructive sleep apnea. Am Rev Respir Dis. 1986 Apr;133(4):662–666. doi: 10.1164/arrd.1986.133.4.662. [DOI] [PubMed] [Google Scholar]
  11. Mezzanotte W. S., Tangel D. J., White D. P. Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism). J Clin Invest. 1992 May;89(5):1571–1579. doi: 10.1172/JCI115751. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Partinen M., Guilleminault C., Quera-Salva M. A., Jamieson A. Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest. 1988 Jun;93(6):1199–1205. doi: 10.1378/chest.93.6.1199. [DOI] [PubMed] [Google Scholar]
  13. Rubinstein I., Colapinto N., Rotstein L. E., Brown I. G., Hoffstein V. Improvement in upper airway function after weight loss in patients with obstructive sleep apnea. Am Rev Respir Dis. 1988 Nov;138(5):1192–1195. doi: 10.1164/ajrccm/138.5.1192. [DOI] [PubMed] [Google Scholar]
  14. Ryan C. F., Lowe A. A., Li D., Fleetham J. A. Magnetic resonance imaging of the upper airway in obstructive sleep apnea before and after chronic nasal continuous positive airway pressure therapy. Am Rev Respir Dis. 1991 Oct;144(4):939–944. doi: 10.1164/ajrccm/144.4.939. [DOI] [PubMed] [Google Scholar]
  15. Shepard J. W., Jr, Thawley S. E. Localization of upper airway collapse during sleep in patients with obstructive sleep apnea. Am Rev Respir Dis. 1990 May;141(5 Pt 1):1350–1355. doi: 10.1164/ajrccm/141.5_Pt_1.1350. [DOI] [PubMed] [Google Scholar]
  16. Stauffer J. L., Zwillich C. W., Cadieux R. J., Bixler E. O., Kales A., Varano L. A., White D. P. Pharyngeal size and resistance in obstructive sleep apnea. Am Rev Respir Dis. 1987 Sep;136(3):623–627. doi: 10.1164/ajrccm/136.3.623. [DOI] [PubMed] [Google Scholar]
  17. Stein M. G., Gamsu G., de Geer G., Golden J. A., Crumley R. L., Webb W. R. Cine CT in obstructive sleep apnea. AJR Am J Roentgenol. 1987 Jun;148(6):1069–1074. doi: 10.2214/ajr.148.6.1069. [DOI] [PubMed] [Google Scholar]
  18. Sullivan C. E., Issa F. G., Berthon-Jones M., McCauley V. B., Costas L. J. Home treatment of obstructive sleep apnoea with continuous positive airway pressure applied through a nose-mask. Bull Eur Physiopathol Respir. 1984 Jan-Feb;20(1):49–54. [PubMed] [Google Scholar]
  19. Suratt P. M., McTier R. F., Wilhoit S. C. Upper airway muscle activation is augmented in patients with obstructive sleep apnea compared with that in normal subjects. Am Rev Respir Dis. 1988 Apr;137(4):889–894. doi: 10.1164/ajrccm/137.4.889. [DOI] [PubMed] [Google Scholar]
  20. Sériès F., Roy N., Marc I. Effects of sleep deprivation and sleep fragmentation on upper airway collapsibility in normal subjects. Am J Respir Crit Care Med. 1994 Aug;150(2):481–485. doi: 10.1164/ajrccm.150.2.8049833. [DOI] [PubMed] [Google Scholar]
  21. Tangel D. J., Mezzanotte W. S., White D. P. Influence of sleep on tensor palatini EMG and upper airway resistance in normal men. J Appl Physiol (1985) 1991 Jun;70(6):2574–2581. doi: 10.1152/jappl.1991.70.6.2574. [DOI] [PubMed] [Google Scholar]
  22. Yildirim N., Fitzpatrick M. F., Whyte K. F., Jalleh R., Wightman A. J., Douglas N. J. The effect of posture on upper airway dimensions in normal subjects and in patients with the sleep apnea/hypopnea syndrome. Am Rev Respir Dis. 1991 Oct;144(4):845–847. doi: 10.1164/ajrccm/144.4.845. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES