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Cited by 57Obstructive Sleep Apnea ResearchNeuroscience of respiration and sleepRespiratory Support and Mechanisms

Dynamic loop gain increases upon adopting the supine body position during sleep in patients with obstructive sleep apnoea

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Joosten, Simon A., Landry, Shane A., Sands, Scott A., Terrill, Philip I., Mann, Dwayne, Andara, Christopher, Skuza, Elizabeth, Turton, Anthony +3 more·2017·Respirology
DOI 10.1111/resp.13108PMC PMC5895090
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Abstract

Background and objective: Obstructive sleep apnoea (OSA) is typically worse in the supine versus lateral sleeping position. One potential factor driving this observation is a decrease in lung volume in the supine position which is expected by theory to increase a key OSA pathogenic factor: dynamic ventilatory control instability (i.e. loop gain). We aimed to quantify dynamic loop gain in OSA patients in the lateral and supine positions, and to explore the relationship between change in dynamic loop gain and change in lung volume with position. Methods: Data from 20 patients enrolled in previous studies on the effect of body position on OSA pathogenesis were retrospectively analysed. Dynamic loop gain was calculated from routinely collected polysomnographic signals using a previously validated mathematical model. Lung volumes were measured in the awake state with a nitrogen washout technique. Results: Dynamic loop gain was significantly higher in the supine than in the lateral position (0.77 ± 0.15 vs 0.68 ± 0.14, P = 0.012). Supine functional residual capacity (FRC) was significantly lower than lateral FRC (81.0 ± 15.4% vs 87.3 ± 18.4% of the seated FRC, P = 0.021). The reduced FRC we observed on moving to the supine position was predicted by theory to increase loop gain by 10.2 (0.6, 17.1)%, a value similar to the observed increase of 8.4 (−1.5, 31.0)%. Conclusion: Dynamic loop gain increased by a small but statistically significant amount when moving from the lateral to supine position and this may, in part, contribute to the worsening of OSA in the supine sleeping position.

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Crossref · 10.1111/resp.13108

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  • High loop gain due to high plant gain is clinically less common, but situations in which lung volume decreases (e.g., supine sleep) can increase overall loop gain.

    “High loop gain due to high plant gain is clinically less common, but situations in which the lung volume decreases (e.g., supine sleep)355 can increase overall loop gain.”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [355]

    The Results report that supine lung volume was lower than lateral lung volume and that measured dynamic loop gain increased. The Discussion distinguishes this from steady-state loop gain, which it says is unchanged with body position. The cited paper therefore supports the claim for dynamic loop gain, but not an unqualified increase in loop gain overall. (LLM, conf=0.85)

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Research works printed but not linked: 2

  1. [20]Wellman A Edwards BA Sands SA Owens RL Nemati S Butler J Passaglia CL Jackson AC Malhotra A White DP A simplified method for determining phenotypic traits in patients with obstructive sleep apnea J Appl Physiol 2013 114 911 22 23349453 PMC3633440
  2. [24]Khoo MCK Kronauer RE Strohl KP Slutsky AS Factors inducing periodic breathing in humans: a general model Journal of Applied Physiology 1982 53 644 59 7129986

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Authors
Joosten, S. A., Landry, S. A., Sands, S. A., Terrill, P. I., Mann, D., Andara, C., Skuza, E., Turton, A., Berger, P., Hamilton, G. S., & Edwards, B. A.
Affiliations
  • Monash Medical Centre (AU)
  • Monash University (AU)
  • Brigham and Women's Hospital (US)
  • The University of Queensland (AU)
  • Monash Partners – Epworth Sleep Centre Melbourne VIC Australia
Corresponding author
Joosten, Simon A.
ORCID
Venue
Respirology
Publisher
Wiley
Published
2017-07-20
Volume
22
Issue
8
Pages
1662-1669
ISSN
  • 1323-7799 (ISSN-L)
  • 1440-1843
DOI
10.1111/resp.13108
PMC
PMC5895090
OpenAlex
W2738262010
Cited by
57
References
33
Citations by year
2026: 8 · 2025: 7 · 2024: 8 · 2023: 9 · 2022: 4 · 2021: 10 · 2020: 3 · 2019: 4 · 2018: 4
FWCI
2.22
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Respirology (publishedVersion)
  • Monash University Research Portal (Monash University) (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Health and Medical Research Council (1035115, 1064163)
  • American Heart Association (15SDG25890059)
  • National Institutes of Health (R01HL128658, 2R01HL102321, P01HL10050580)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords
obstructive sleep apnea, supine sleeping, functional residual capacity, lung volume, OSA pathogenesis, posture effects
MeSH terms
Adult, Female, Functional Residual Capacity, Humans, Lung, Male, Middle Aged, Models, Theoretical, Posture, Respiratory Function Tests, Retrospective Studies, Sleep, Statistics as Topic, Supine Position, Sleep Apnea, Obstructive

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