PERIODIC BREATHING AND THE PATHOGENESIS OF OCCLUSIVE SLEEP APNEAS

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Abstract
To study the relationship between sleep-induced periodic breathing and the development of occlusive sleep apneas, 6 patients with hypersommia-sleep apnea syndrome were studied during nocturnal sleep before and .apprx. 1 mo. after therapeutic tracheostomy. Post-tracheostomy studies were performed in open and closed tracheostomy states. Sleep-induced periodic breathing resembling the pattern of Cheyne-Stokes breathing was observed in all patients before and after tracheostomy, even when tracheostomy was left open. When tracheostomy was closed, all patients developed periodic hypopneas with significant O2 desaturation, and 4 patients developed occlusive apneas at the nadir of the periodic changes. Apnea and desaturation indexes during closed tracheostomy were significantly lower than their respective pretracheostomy values. Sleep-induced periodic breathing, which represents an instability of respiratory control, is primary to the development of occlusive apneas, and the periodicity observed is exaggerated by hypoxemia. Comparison of pre- and post-tracheostomy studies indicate a signficant improvement in the underlying disorder most likely caused by the elimination of nocturnal hypoxemia and sleep fragmentation.