Regional distribution of ventilation in patients with obstructive sleep apnea: the role of thoracic electrical impedance tomography (EIT) monitoring

The aim of our study was to apply the electrical impedance tomography (EIT) technique to the study of ventilation during wake and NREM and REM sleep in patients with obstructive sleep apneas (OSA). This is a prospective, observational, monocentric, pilot study in a neurology department with a sleep disorder center. Inclusion criteria were age ae<yen>18 years, both gender, and diagnosis of OSA. Exclusion criteria were the contraindications to the thoracic EIT. All patients underwent laboratory-based polysomnography (PSG) alongside thoracic EIT. Primary endpoint was to compare the global impedance (GI) among the conditions: "Wake" vs "Sleep," "NREM" vs "REM," and "OSA" vs "Non-OSA." Secondary endpoint was to measure the regional distribution of impedance in the four regions of interest (ROIs), in each condition. Of the 17 consecutive patients enrolled, two were excluded because of poor-quality EIT tracings. Fifteen were analyzed, 10 men and 5 women, mean age 51.6 +/- 14.4 years. GI was higher in Wake vs Sleep (Wake 13.24 +/- 11.23; Sleep 12.56 +/- 13.36; p < 0.01), in NREM vs REM (NREM 13.48 +/- 13.43; REM 0.59 +/- 0.01; p < 0.01), and in Non-OSA vs OSA (Non-OSA 10.50 +/- 12.99; OSA 18.98 +/- 10.06; p < 0.01). No significant differences were observed in the regional distribution of impedance between Wake and Sleep (chi (2) = 3.66; p = 0.299) and between Non-OSA and OSA (chi (2) = 1.00; p = 0.799); conversely, a significant difference was observed between NREM and REM sleep (chi (2) = 62.94; p < 0.001). To our knowledge, this is the first study that addresses the issue of regional ventilation in OSA patients during sleep. Thoracic electrical impedance changes through the sleep-wake cycle and during obstructive events. The application of thoracic EIT can prove a valuable additional strategy for the evaluation of OSA patients.