Exposure to intermittent hypoxia and sustained hypercapnia reduces therapeutic CPAP in participants with obstructive sleep apnea.

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Exposure to intermittent hypoxia and sustained hypercapnia reduces therapeutic CPAP in participants with obstructive sleep apnea.

J Appl Physiol (1985). 2017 Jul 06;:jap.00204.2017

Authors: El-Chami M, Sudan S, Lin HS, Mateika JH

Abstract
PURPOSE: To determine if exposure to mild intermittent hypoxia leads to a reduction in the therapeutic continuous positive airway pressure required to eliminate breathing events.
METHODS: Ten male participants were treated with twelve 2-minute episodes of hypoxia (PETO2 ≈ 50 mmHg) separated by 2-minute intervals of normoxia in the presence of PETCO2 that was sustained 3 mmHg above baseline. During recovery from the last episode the positive airway pressure was reduced in a step-wise fashion until flow limitation was evident. The participants also completed a sham protocol under normocapnic conditions, which mimicked the timeframe of the intermittent hypoxia protocol.
RESULTS: After exposure to intermittent hypoxia the therapeutic pressure was significantly reduced (i.e. 5 cmH2O) without evidence of flow limitation (103.4 ± 6.3 % of baseline, P = 0.5) or increases in upper airway resistance (95.6 ± 15.0 % of baseline, P = 0.6). In contrast, a similar decrease in pressure was accompanied by flow limitation (77.0 ± 1.8 % of baseline, P = 0.001) and an increase in upper airway resistance (167.2 ± 17.5 % of baseline, P = 0.01) after the sham protocol.
CONCLUSION: Consistent with the initiation of long-term facilitation of upper airway muscle activity exposure to intermittent hypoxia reduced the therapeutic pressure required to eliminate apneic events which could improve treatment compliance. This possibility coupled with the potential beneficial effects of intermittent hypoxia on co-morbidities linked to sleep apnea suggests that mild intermittent hypoxia may have a multipronged therapeutic effect on sleep apnea.

PMID: 28684586 [PubMed - as supplied by publisher]

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