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The Effect of Simulated Obstructive Apneas on Mechanical Characteristics of Lower Airways in Individuals with Asthma

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Abstract

Increased negative intrathoracic pressure that occurs during pharyngeal obstruction can increase thoracic fluid volume that may contribute to lower airway narrowing in individuals with obstructive sleep apnea (OSA) and asthma. Our previous study showed that fluid accumulation in the thorax induced by simulated OSA can increase total respiratory resistance. However, the effect of fluid shift on lower airway narrowing has not been investigated. To examine the effect of fluid accumulation in the thorax on the resistance of the lower airway. Non-asthma participants and individuals with (un)controlled asthma were recruited and underwent a single-day experiment. A catheter with six pressure sensors was inserted through the nose to continuously measure pressure at different sites of the airway, while a pneumotachograph was attached to a mouthpiece to record airflow. To simulate obstructive apneas, participants performed 25 Mueller maneuvers (MMs) while lying supine. Using the recordings of pressure sensor and airflow, total respiratory (RT), lower respiratory components (RL), and upper airway (RUA) resistances were calculated before and after MMs. Generalized estimation equation method was used to find the predictors of RL among variables including age, sex, body mass index, and the effect of MMs and asthma. Eighteen participants were included. Performing MMs significantly increased RT (2.23 ± 2.08 cmH2O/L/s, p = 0.003) and RL (1.52 ± 2.00 cmH2O/L/s, p = 0.023) in participants with asthma, while only RL was increased in non-asthma group (1.96 ± 1.73 cmH2O/L/s, p = 0.039). We found the model with age, and the effect of MMs and asthma severity generated the highest correlation (R2 = 0.69, p < 0.001). We provide evidence that fluid accumulation in the thorax caused by excessive intrathoracic pressure increases RL in both non-asthma and asthma groups. The changes in RL were related to age, having asthma and the effect of simulated OSA. This can explain the interrelationship between OSA and asthma.

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Funding

This study was funded by Ontario Lung Association, Canadian Respiratory Research Network and Ontario Centre of Excellence. NM was supported by a scholarship from Borealis AI and Royal Bank of Canada. TDB was supported by the University of Toronto’s Godfrey S. Pettit Chair in Respiratory Medicine.

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Authors and Affiliations

  1. KITE, University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada

    Nasim Montazeri Ghahjaverestan, Shaghayegh Chavoshian, Xiaoshu Cao, T. Douglas Bradley & Azadeh Yadollahi

  2. Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada

    Nasim Montazeri Ghahjaverestan, Shaghayegh Chavoshian, Xiaoshu Cao & Azadeh Yadollahi

  3. Department of Medicine, University of Toronto, Toronto, ON, Canada

    T. Douglas Bradley & Kenneth R. Chapman

  4. Department of Medicine, Toronto General Hospital, University Health Network, Toronto, ON, Canada

    T. Douglas Bradley & Susan M. Tarlo

  5. Toronto Western Hospital, University Health Network, Toronto, ON, Canada

    Matthew Stanbrook

  6. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Matthew Stanbrook

  7. Asthma & Airway Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada

    Kenneth R. Chapman

  8. University Health Network Toronto Rehabilitation Institute, Room 12-106, 550 University Ave., Toronto, ON, M5G 2A2, Canada

    Azadeh Yadollahi

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  1. Nasim Montazeri Ghahjaverestan
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Contributions

Conception and design: NMG, AY. Formalizing hypothesis: XC, TDB, AY. Patient assessment and recruitment: XC, SMT, MS, KRC. Data acquisition: XC, TDB. Data analysis: NMG. Data interpretation: NMG, XC, TDB, AY. Drafting the manuscript for important intellectual content: NMG, SC. Reviewing manuscript: SC, XC, TDB, SMT, KRC, AY. Approving final version of manuscript for submission: AY.

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Correspondence to Azadeh Yadollahi.

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Associate Editor Joel Stitzel oversaw the review of this article.

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Montazeri Ghahjaverestan, N., Chavoshian, S., Cao, X. et al. The Effect of Simulated Obstructive Apneas on Mechanical Characteristics of Lower Airways in Individuals with Asthma. Ann Biomed Eng (2024). https://doi.org/10.1007/s10439-024-03475-3

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