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Pulse transit time in patients with sleep-disordered breathing

Egyptian Journal of Bronchology volume 12, pages 114–118 (2018)Cite this article

Abstract

Background

Pulse transit time (PTT) represents a noninvasive marker of sleep fragmentation in patients with obstructive sleep apnea–hypopnea syndrome (OSAHS). Little is known regarding changes in PTT in patients with excessive daytime sleepiness associated with nocturnal inspiratory flow limitation (IFL) without apneas or desaturation.

Patients and methods

A total of 20 patients with nocturnal IFL were age and sex matched with a group of patients with OSAHS and another without significant breathing disorders during sleep [nonflow limited (NFL)]. PTT arousal index (PTT Ar) is the number of PTT arousals per hour.

Results

Overall, 20 patients with IFL were age and sex matched with two groups: one with OSAHS and another without significant sleep-disordered breathing (SDB) (NFL). There was a significant increase in the median BMI of the IFL group compared with the NFL group (40 vs. 30; P<0.05) but not with the OSAHS group (40 vs. 44; P>0.05). The PTT Ar in the IFL group (36.5/h) was significantly higher than that in the NFL group (16.3/h) and lower than that observed in the OSAHS group (60/h; P<0.001). PTT Ar correlated positively with BMI, apnea–hypopnea index, oxygen desaturation index, respiratory disturbance index, snoring index, and Epworth sleepiness scale.

Conclusion

The PTT Ar increased with SDB with significantly higher values in patients with excessive daytime sleepiness associated with nocturnal IFL compared with controls. Patients with IFL were mainly females with an elevated BMI. Thus, PTT could be used as a marker of sleep fragmentation apart from electroencephalogram in the diagnosis of SDB.

References

  1. Vanninen E, Tuunainen A, Kansanen M, Uusitupa M, Lansimies E. Cardiac sympathovagal balance during sleep apnoea episodes. Clin Physiol 1996; 16:209–216.

    Article  CAS  Google Scholar 

  2. Argod J, Pepin JL, Smith RP, Levy P. Comparison of esophageal pressure with pulse transit time as a measure of respiratory effort for scoring obstructive nonapneic respiratory events. Am J Respir Crit Care Med 2000; 162:87–93.

    Article  CAS  Google Scholar 

  3. Pepin JL, Tamisier R, Borel JC, Baguet JP, Levy P. A critical review of peripheral arterial tone and pulse transit time as indirect diagnostic methods for detecting sleep disordered breathing and characterizing sleep structure. Curr Opin Pulm Med 2009; 15:550–558.

    Article  Google Scholar 

  4. Smith RP, Argod J, Pepin JL, Levy PA. Pulse transit time: an appraisal of potential clinical applications. Thorax 1999; 54:452–457.

    Article  CAS  Google Scholar 

  5. Pitson DJ, Sandell A, van Den Hout R, Stradling JR. Use of pulse transit time as a measure of inspiratory effort in patients with obstructive sleep apnoea. Eur Respir J 1995; 8:1669–1674.

    Article  CAS  Google Scholar 

  6. Martin SE, Wraith PK, Deary IJ, Douglas NJ. The effect of non-visible sleep fragmentation on daytime function. Am J Respir Crit Care Med 1997; 155:1596–1601.

    Article  CAS  Google Scholar 

  7. Palombini LO, Tufik S, Rapoport DM, Ayappa IA, Guilleminault C, de Godoy LB, et al. Inspiratory flow limitation in a normal population of adults in São Paulo, Brazil. Sleep 2013; 36:1663–1668.

  8. Arora N, Meskill G, Guilleminault C. The role of flow limitation as an important diagnostic tool and clinical finding in mild sleep-disordered breathing. Sleep Sci 2015; 8:134–142.

    Article  Google Scholar 

  9. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8:597–619.

    Article  Google Scholar 

  10. Guilleminault C, Huang YS. Pediatric obstructive sleep apnea: a short review of clinical aspects. Pediatr Respirol Crit Care Med 2017; 1:39–45.

    Article  Google Scholar 

  11. Banerjee D, Yee BJ, Piper AJ, Zwillich CW, Grunstein RR. Obesity hypoventilation syndrome: hypoxemia during continuous positive airway pressure. Chest 2007; 131:1678–1684.

    Article  Google Scholar 

  12. Chakrabarti B, Emegbo S, Craig S, Duffy N, O’Reilly J. Pulse transit time changes in subjects exhibiting sleep disordered breathing. Respir Med 2017; 122:18–22.

    Article  Google Scholar 

  13. Pépin J.L., Delavie N, Pin I, Deschaux C, Argod J, Bost M, et al. Pulse transit time improves detection of sleep respiratory events and microarousals in children. Chest 2005; 127:722–730.

    Article  Google Scholar 

  14. Nisbet LC, Yiallourou SR, Nixon GM, Biggs SN, Davey MJ, Horne RS, et al. Characterization of the acute pulse transit time response to obstructive apneas and hypopneas in preschool children with sleep-disordered breathing. Sleep Med 2013; 14:1123–1131.

    Article  Google Scholar 

  15. Katz ES, Lutz J, Black C, Marcus CL. Pulse transit time as a measure of arousal and respiratory effort in children with sleep-disordered breathing. Pediatr Res 2003; 53:580–588.

    Article  Google Scholar 

  16. Schwartz DJ. The pulse transit time arousal index in obstructive sleep apnea before and after CPAP. Sleep Med 2005; 6: 199–203.

    Article  Google Scholar 

  17. Meurice JC, Paquereau J, Denjean A, Patte F, Series F. Influence of correction of flow limitation on continuous positive airway pressure efficiency in sleep apnoea/hypopnoea syndrome. Eur Respir J 1998; 11:1121–1127.

    Article  CAS  Google Scholar 

  18. Chakrabarti B, Emegbo S, Craig S, Heseltine J, Wright T, Duffy N, et al. P111 respiratory flow limitation in the absence of obstructive sleep apnoea responds to CPAP therapy. Thorax 2015;70:A131.

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Authors and Affiliations

  1. Department of Chest Disease, Faculty of Medicine, Banha University, Banha, 13512, Egypt

    Marwa El-Sayed El-Naggar MD (Lecteurer of Chest Diseases)

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  1. Marwa El-Sayed El-Naggar MD
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Correspondence to Marwa El-Sayed El-Naggar MD.

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El-Naggar, M.ES. Pulse transit time in patients with sleep-disordered breathing. Egypt J Bronchol 12, 114–118 (2018). https://doi.org/10.4103/ejb.ejb_49_17

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  • DOI: https://doi.org/10.4103/ejb.ejb_49_17

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