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Fluid Shift by Lower Body Positive Pressure Increases Pharyngeal Resistance in Healthy Subjects
Abstract
Introduction: Fluid displacement into nuchal and peripharyngeal soft tissues while recumbent may contribute to narrowing and increased airflow resistance of the pharynx (Rph), and predispose to pharyngeal collapse in patients at risk for obstructive sleep apnea. Objectives: To determine whether displacement of fluid from the lower body to the neck will increase both neck circumference and Rph in healthy subjects. Methods: In 11 healthy, nonobese subjects, studied while awake and supine, leg fluid volume, neck circumference, and Rph were measured at baseline. Subjects were then randomized to a control period or to application of lower body positive pressure (LBPP) of 40 mm Hg via antishock trousers to displace fluid from the legs, after which they crossed over to the other arm. Baseline measurements were repeated at 1 and 5 min during the control and LBPP periods. Results: Compared with the control period, application of LBPP caused a significant reduction in leg fluid volume (p < 0.001) and a significant increase in neck circumference (p = 0.004). Rph remained stable during the control period, but increased significantly from baseline after 1 and 5 min of LBPP (from 0.43 ± 0.10 to 0.60 ± 0.11 cm H2O/L/s, p = 0.034, and to 0.87 ± 0.19 cm H2O/L/s, p < 0.001, compared with baseline, respectively). Conclusions: Fluid displacement from the legs by LBPP increases neck circumference and Rph in healthy subjects. These findings suggest the hypothesis that fluid displacement to the upper body during recumbency may predispose to pharyngeal obstruction during sleep, especially in fluid overload states, such as heart and renal failure.
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“This central accumulation of fluid has been shown to contribute to upper airway edema with associated increases in upper airway resistance, thereby worsening OSA.284,285”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [284]
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Metadata
- Authors
- Chiu, K.-L., Ryan, C. M., Shiota, S., Ruttanaumpawan, P., Arzt, M., Haight, J. S., Chan, C. T., Floras, J. S., & Bradley, T. D.
- Affiliations
- Mount Sinai Hospital (CA)
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-12
- Volume
- 174
- Issue
- 12
- Pages
- 1378-1383
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2116187155
- Cited by
- 226
- References
- 48
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 1 · 2023: 7 · 2022: 7 · 2021: 6 · 2020: 8 · 2019: 10 · 2018: 14 · 2017: 12 · 2016: 10 · 2015: 19 · 2014: 14 · 2013: 10 · 2012: 20
- FWCI
- 9.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › 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
- lower body positive pressure, fluid shifts, neck circumference, pharyngeal collapse, obstructive sleep apnea, supine position, fluid overload
- MeSH terms
- Adult, Airway Resistance, Female, Humans, Male, Middle Aged, Neck, Pharynx, Pressure, Fluid Shifts
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