Role of esophageal manometry in polysomnography of patients with chronic respiratory failure

https://doi.org/10.4081/monaldi.2021.1756

Authors

  • Debasis Behera | debasis.behera3@kims.ac.in Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
  • J C Suri Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
  • Pranav Ish Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
  • Ruchi Rekha Behera Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
  • Shibdas Chakrabarti Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
  • Viswesvaran Balasubramanian Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

Abstract

Esophageal pressure (Pes) monitoring is performed during polysomnography (PSG) with a thin, water-filled catheter connected to a transducer. The resulting quantitative assessment of respiratory effort can aid in the accurate diagnosis of sleep-related breathing disorders.  This was a prospective observational study using Pes in PSG for thirty patients with chronic respiratory failure (CRF) conducted in the Department of Pulmonary, Critical Care and Sleep Medicine at a tertiary care center of North India. Sleep Scoring was done by conventional method and using esophageal manometry and compared- Polysomnography normal without esophageal manometry recording (PSGN) and polysomnography with esophageal manometry scoring (PSGE). AHI index was similar in both groups. However, RERAs were diagnosed easily using Pes resulting in significant increase in RDI and even reclassification in terms of severity of sleep apnea. Besides, Pes was also useful to distinguish obstructive from central hypopnea which cannot be distinguished by routine PSG which can help guide therapy particularly in chronic respiratory failure patients with hypoventilation. Such patients with hypoventilation often require bilevel positive airway pressure as ventilatory support. Central hypopneas and apneas with hypercapnia may require a higher-pressure support, a backup rate or even advanced volume assured modes of ventilation.  Thus, it can be concluded that Pes in PSG remains a safe and generally well-tolerated procedure. Use of Pes aids to detect RERA and thereby respiratory disturbance index (RDI); a better marker of Sleep related breathing disorder rather than AHI. It also helps in differentiate between obstructive and central hypopnea.

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References

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Published
2021-07-22
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Section
Pneumology - Original Articles
Keywords:
Chronic respiratory failure, Sleep-disordered breathing, Esophageal Manometry, RERA, RDI
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How to Cite
Behera, Debasis, J C Suri, Pranav Ish, Ruchi Rekha Behera, Shibdas Chakrabarti, and Viswesvaran Balasubramanian. 2021. “Role of Esophageal Manometry in Polysomnography of Patients With Chronic Respiratory Failure”. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2021.1756.

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