asthma & osas
DESCRIPTION
Ostrutive Sleep Apnea Syndrome (OSAS) and Allergic Respiratory Diseases. ASTHMA & OSAS. Fulvio Braido Allergy and Respiratory Diseases Department University of Genoa. Normal subject = 8%. Asthmatic subjects = 50%. Nocturnal bronchial narrowing depends - PowerPoint PPT PresentationTRANSCRIPT
ASTHMA amp OSAS
Fulvio Braido Allergy and Respiratory Diseases Department
University of Genoa
Ostrutive Sleep Apnea Syndrome (OSAS) and
Allergic Respiratory Diseases
Normal subject = 8
Asthmatic subjects = 50
Nocturnal bronchial narrowing dependson the timing of the patientrsquos sleep
Mechanisms of nocturnal asthma
Probable
Circadian featuresSleep state
Possible
Airways coolingSupine postureAllergic FactorsGastroesophageal refluxSnoring or Sleep Apnea
122 patients
The level of asthma control results to be inversely correlated to the presence of sleep disturbances
Patients with good control report less frequent and less severe sleep disturbancescompared to uncontrolled subjects
A significant percentage of subjects (11-20) having achieved total control of asthma stillreport sleep disturbances that contribute to increase the impact of the disease and to impair quality of life
Increased incidence of asthma in overweighed and obese subjects
Beuther DA Sutherland ER Overweight Obesity and Incident Asthma A Meta-analysis of Prospective Epidemiologic Studies
AJRCCM 2007175661-666
Beuther DA et al Pulmonary Perspectives Obesity and Asthma Am J Respir Crit Care Med 2006174112-9
Obesity and Asthma
Aim To determine wheter a high OSA risk is associated to not well-controlled asthma
Sleep Disorders Questionnaire (SA-SDQ)
Asthma Control Questionnaire (ACQ)
Multivariate Logistic Regression Models of Not-Well-Controlled Asthma on High OSA Risk with Adjustment for Factors Known To Worsen Asthma Control
OSA is a potential contributor to overall asthma control on a much larger scale and indipendent ot the other known contributors to asthma control
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Normal subject = 8
Asthmatic subjects = 50
Nocturnal bronchial narrowing dependson the timing of the patientrsquos sleep
Mechanisms of nocturnal asthma
Probable
Circadian featuresSleep state
Possible
Airways coolingSupine postureAllergic FactorsGastroesophageal refluxSnoring or Sleep Apnea
122 patients
The level of asthma control results to be inversely correlated to the presence of sleep disturbances
Patients with good control report less frequent and less severe sleep disturbancescompared to uncontrolled subjects
A significant percentage of subjects (11-20) having achieved total control of asthma stillreport sleep disturbances that contribute to increase the impact of the disease and to impair quality of life
Increased incidence of asthma in overweighed and obese subjects
Beuther DA Sutherland ER Overweight Obesity and Incident Asthma A Meta-analysis of Prospective Epidemiologic Studies
AJRCCM 2007175661-666
Beuther DA et al Pulmonary Perspectives Obesity and Asthma Am J Respir Crit Care Med 2006174112-9
Obesity and Asthma
Aim To determine wheter a high OSA risk is associated to not well-controlled asthma
Sleep Disorders Questionnaire (SA-SDQ)
Asthma Control Questionnaire (ACQ)
Multivariate Logistic Regression Models of Not-Well-Controlled Asthma on High OSA Risk with Adjustment for Factors Known To Worsen Asthma Control
OSA is a potential contributor to overall asthma control on a much larger scale and indipendent ot the other known contributors to asthma control
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Nocturnal bronchial narrowing dependson the timing of the patientrsquos sleep
Mechanisms of nocturnal asthma
Probable
Circadian featuresSleep state
Possible
Airways coolingSupine postureAllergic FactorsGastroesophageal refluxSnoring or Sleep Apnea
122 patients
The level of asthma control results to be inversely correlated to the presence of sleep disturbances
Patients with good control report less frequent and less severe sleep disturbancescompared to uncontrolled subjects
A significant percentage of subjects (11-20) having achieved total control of asthma stillreport sleep disturbances that contribute to increase the impact of the disease and to impair quality of life
Increased incidence of asthma in overweighed and obese subjects
Beuther DA Sutherland ER Overweight Obesity and Incident Asthma A Meta-analysis of Prospective Epidemiologic Studies
AJRCCM 2007175661-666
Beuther DA et al Pulmonary Perspectives Obesity and Asthma Am J Respir Crit Care Med 2006174112-9
Obesity and Asthma
Aim To determine wheter a high OSA risk is associated to not well-controlled asthma
Sleep Disorders Questionnaire (SA-SDQ)
Asthma Control Questionnaire (ACQ)
Multivariate Logistic Regression Models of Not-Well-Controlled Asthma on High OSA Risk with Adjustment for Factors Known To Worsen Asthma Control
OSA is a potential contributor to overall asthma control on a much larger scale and indipendent ot the other known contributors to asthma control
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Mechanisms of nocturnal asthma
Probable
Circadian featuresSleep state
Possible
Airways coolingSupine postureAllergic FactorsGastroesophageal refluxSnoring or Sleep Apnea
122 patients
The level of asthma control results to be inversely correlated to the presence of sleep disturbances
Patients with good control report less frequent and less severe sleep disturbancescompared to uncontrolled subjects
A significant percentage of subjects (11-20) having achieved total control of asthma stillreport sleep disturbances that contribute to increase the impact of the disease and to impair quality of life
Increased incidence of asthma in overweighed and obese subjects
Beuther DA Sutherland ER Overweight Obesity and Incident Asthma A Meta-analysis of Prospective Epidemiologic Studies
AJRCCM 2007175661-666
Beuther DA et al Pulmonary Perspectives Obesity and Asthma Am J Respir Crit Care Med 2006174112-9
Obesity and Asthma
Aim To determine wheter a high OSA risk is associated to not well-controlled asthma
Sleep Disorders Questionnaire (SA-SDQ)
Asthma Control Questionnaire (ACQ)
Multivariate Logistic Regression Models of Not-Well-Controlled Asthma on High OSA Risk with Adjustment for Factors Known To Worsen Asthma Control
OSA is a potential contributor to overall asthma control on a much larger scale and indipendent ot the other known contributors to asthma control
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
122 patients
The level of asthma control results to be inversely correlated to the presence of sleep disturbances
Patients with good control report less frequent and less severe sleep disturbancescompared to uncontrolled subjects
A significant percentage of subjects (11-20) having achieved total control of asthma stillreport sleep disturbances that contribute to increase the impact of the disease and to impair quality of life
Increased incidence of asthma in overweighed and obese subjects
Beuther DA Sutherland ER Overweight Obesity and Incident Asthma A Meta-analysis of Prospective Epidemiologic Studies
AJRCCM 2007175661-666
Beuther DA et al Pulmonary Perspectives Obesity and Asthma Am J Respir Crit Care Med 2006174112-9
Obesity and Asthma
Aim To determine wheter a high OSA risk is associated to not well-controlled asthma
Sleep Disorders Questionnaire (SA-SDQ)
Asthma Control Questionnaire (ACQ)
Multivariate Logistic Regression Models of Not-Well-Controlled Asthma on High OSA Risk with Adjustment for Factors Known To Worsen Asthma Control
OSA is a potential contributor to overall asthma control on a much larger scale and indipendent ot the other known contributors to asthma control
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Increased incidence of asthma in overweighed and obese subjects
Beuther DA Sutherland ER Overweight Obesity and Incident Asthma A Meta-analysis of Prospective Epidemiologic Studies
AJRCCM 2007175661-666
Beuther DA et al Pulmonary Perspectives Obesity and Asthma Am J Respir Crit Care Med 2006174112-9
Obesity and Asthma
Aim To determine wheter a high OSA risk is associated to not well-controlled asthma
Sleep Disorders Questionnaire (SA-SDQ)
Asthma Control Questionnaire (ACQ)
Multivariate Logistic Regression Models of Not-Well-Controlled Asthma on High OSA Risk with Adjustment for Factors Known To Worsen Asthma Control
OSA is a potential contributor to overall asthma control on a much larger scale and indipendent ot the other known contributors to asthma control
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Beuther DA et al Pulmonary Perspectives Obesity and Asthma Am J Respir Crit Care Med 2006174112-9
Obesity and Asthma
Aim To determine wheter a high OSA risk is associated to not well-controlled asthma
Sleep Disorders Questionnaire (SA-SDQ)
Asthma Control Questionnaire (ACQ)
Multivariate Logistic Regression Models of Not-Well-Controlled Asthma on High OSA Risk with Adjustment for Factors Known To Worsen Asthma Control
OSA is a potential contributor to overall asthma control on a much larger scale and indipendent ot the other known contributors to asthma control
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Aim To determine wheter a high OSA risk is associated to not well-controlled asthma
Sleep Disorders Questionnaire (SA-SDQ)
Asthma Control Questionnaire (ACQ)
Multivariate Logistic Regression Models of Not-Well-Controlled Asthma on High OSA Risk with Adjustment for Factors Known To Worsen Asthma Control
OSA is a potential contributor to overall asthma control on a much larger scale and indipendent ot the other known contributors to asthma control
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
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- Slide 20
- Slide 21
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Multivariate Logistic Regression Models of Not-Well-Controlled Asthma on High OSA Risk with Adjustment for Factors Known To Worsen Asthma Control
OSA is a potential contributor to overall asthma control on a much larger scale and indipendent ot the other known contributors to asthma control
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
OR 34
Eur Respir J 2005 26 812ndash818
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Brochial Asthma
Allergen bronchial challenge
EosinofphilIL-5
BasophilMast cell degranlulation
EosinophilICAM-1VCAM-1
Allergen Challenge
nose-bronchial reflex
Allergen
Post nasal drip
Citokine
Loss ofFilter ability
Viral ifection
Bone marrow
Stem cell
Allergic Rhinitis
United Airways Disease
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Multiple Pro-Inflammatory Factors in Allergic Rhinitis Affect Sleep and Symptoms
Mediator Effect on Sleep
HistamineBalance between wakefulness and sleep arousal
uarr nasal obstruction rhinorrhea amp pruritus
CysLTuarr Slow-wave sleep uarr Sleep-disordered breathing uarr Nasal
obstruction rhinorrhea
IL-1
uarr Latency to REM and darr REM durationIL-4
IL-10
Bradykinin uarr Sleep apnea uarr Nasal obstruction amp rhinorrhea
Substance P uarr Latency to REM arousal uarr Nasal obstruction
Adapted from Ferguson Otolaryngol Head Neck Surg 2004130617
Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
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Prospective Clinical Studies Reporting the Impact of Treatment With CPAP on Asthma Outcome in Patients With Concomitant OSAS
Ann Allergy Asthma Immunol 2008101350ndash357
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
Inclusion criteria
1) asthmatic patients who had nighttime symptoms in spite of the optimal medication according to Global Initiative for Asthma (GINA) guidelines
(2) At least one nocturnal awakening or early morning awakening caused by asthmatic symptoms (cough wheeze chest tightnessand breathlessness)
(3) habitual snoring
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
in some patients with nocturnal asthma OSAS may be responsible disease for nocturnal symptoms
In this condition CPAP improves nocturnal symptoms without amelioration in PFT abnormalities
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- Slide 14
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
-
bull Increases mean airway pressure
bull Recruits underventilated alveoli
bull Increases minute ventilation
bull Decreases airways resistance
bull Stabilizes upper aireways
bull Prevents peripheral airways closure
bull Increases end-expiratory lung volume
bull Increases expiratory muscle function
bull Reduces respiratory rate and dyspnea
bull Suppresses OSAS induce vagal stimulation
bull Prevents OSAS induced increased intrathoracic pressure
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
Atmospheric Pressure 0 cm H2O
Transmural pressure= -23 cmH2O - (-30 cmH2O)= +7 cmH2O
Outward recoil of chest wall
Inward recoil of alveoli
Alveolar pressure
-23 cm H2O
Intrapleural pressure-30 cmH2O
Inspiratory force
Flow in
Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
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- Slide 13
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- Slide 18
- Slide 19
- Slide 20
- Slide 21
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Beneficial effects of continuous positive airway pressure (CPAP) in patients with asthma and obstructive sleep apnea (OSA) syndrome
- Slide 1
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
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