Effects of continuous positive airway pressure on upper airway inspiratory dynamics in awake patients with sleep‐disordered breathing

Continuous positive airway pressure (CPAP) is the main treatment of the obstructive sleep apnoea syndrome (OSAS). We assessed its effects on the upper airway (UA) dynamics in response to bilateral anterior magnetic phrenic nerve stimulation (BAMPS) in 17 awake untreated OSAS patients (15 males; 52 ± 7 years) whose effective CPAP ( P eff ) had been determined beforehand by a conventional titration sleep study. All twitch‐related inspirations were flow‐limited, flow first rising to a maximum (V̇ Imax ), then decreasing to a minimum (V̇ Imin ), and then increasing again (M‐shaped pattern). Up to V̇ Imin , the relationship between driving pressure ( P d ) and flow (V̇) could adequately be fitted to a polynomial regression model (V̇= k 1 P d + k 2 P d 2 ; r 2 = 0.71‐0.98, P < 0.0001 ). At atmospheric pressure V̇ Imax was 700 ± 377 ml s −1 , V̇ Imin was 458 ± 306 ml s −1 , k 1 was 154.5 ± 63.9 ml s −1 (cmH 2 O) −1 , and k 2 was 10.7 ± 7.3 ml s −1 (cmH 2 O) −1 . CPAP significantly increased V̇ Imax and V̇ Imin (peak values 1007 ± 332 ml and 837 ± 264 ml s −1 , respectively) as well as k 1 and k 2 (peak values 300.9 ± 178.2 ml s −1 (cmH 2 O) −1 and 55.2 ± 65.3 ml s −1 (cmH 2 O) −1 , respectively). With increasing CPAP, k 1 / k 2 increased up to a peak value before decreasing. We defined as P eff,stim the CPAP value corresponding to the highest k 1 / k 2 value. P eff,stim was correlated with P eff ( P eff = 7.0 ± 2.0; P eff,stim = 6.4 ± 2.6 cmH 2 O; r = 0.886 ; 95 % CI 0.696‐0.960, P < 0.001 ). We conclude that CPAP improves UA dynamics in OSAS and that the therapeutic CPAP to apply can be predicted during wakefulness using BAMPS.