Induction of airway collapse with subatmospheric pressure in awake patients with sleep apnea

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Abstract
To determine whether the pharyngeal airway is abnormal in awake patients with obstructive sleep apnea (OSA), the ability of the pharyngeal airway to resist collapse from subatmospheric pressure applied to the nose was studied in awake subjects, 12 with OSA and 12 controls. Subatmospheric pressure was applied to subjects placed in the supine position through a tightly fitting face mask. Airflow at the mask as well as mask, pharyngeal and esophageal pressures were measured. Ten patients developed airway obstruction when subatmospheric pressures between 17 and 40 cmH20 were applied. Obstruction did not occur in 2 patients with the least OSA. Obstruction did not occur in 10 controls; 1 obese control subject developed partial airway obstruction when -52 cmH20 was applied as did another with -41 cmH20. Patients with significant OSA have an abnormal airway while they are awake; the application of subatmospheric pressure may be a useful screening test to detect OSA.