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Hypercapnic Ventilatory Response in Patients With and Without Obstructive Sleep Apnea^*

Do Age, Gender, Obesity, and Daytime PaCO₂ Matter?

^* From the Department of Medicine, Division of Respirology, University of Alberta, Edmonton, Alberta, Canada. Dr. Sin is supported by a fellowship from the Alberta Heritage Foundation for Medical Research.

Correspondence to: Godfrey C. Man, MB BS, FCCP, 2E4.44 Walter C. Mackenzie Centre, University of Alberta Edmonton, Alberta, Canada; e-mail: mang{at}ualberta.ca

Study objective: To evaluate the relationship between obstructive sleep apnea (OSA) and ventilatory responsiveness to carbon dioxide in both men and women.

Design: An analysis of 219 patients referred to an university-based sleep center between 1989 to 1994 was conducted (104 with OSA and 115 without OSA; 43 women and 176 men). These patients had spirometry and a daytime hypercapnic ventilatory response (HCVR) test that was corrected to the patient’s ability to attain maximal ventilation. Comparisons between OSA and no-OSA groups, as well as between men and women, were made using multivariate modeling techniques.

Results: There was no significant difference in the slope of correlated HCVR (cHCVR) between those with and without OSA (1.57 ± 0.57 vs 1.63 ± 0.66; p = 0.48). In men, an inverse correlation between daytime PCO₂ and cHCVR was observed in both crude and multivariate analyses (crude ß-coefficient = - 0.04 ± 0.02, p = 0.02; adjusted ß-coefficient = 0.07 ± 0.02, p < 0.01). Although age and cHCVR did not share a significant relationship in the crude analysis (crude ß-coefficient = - 0.01 ± 0.01, p = 0.10), with adjustments for confounding variables, a significant inverse relationship between age and cHCVR was observed (ß-coefficient = - 0.02 ± 0.01, p = 0.04). On the other hand, in women, only body mass index (BMI) was positively correlated with cHCVR (crude ß-coefficient = 0.03 ± 0.01, p = 0.01; adjusted ß-coefficient = 0.04 ± 0.01, p < 0.01).

Conclusion: OSA disorder is not associated with a blunted ventilatory chemoresponsiveness to carbon dioxide. Elevated PaCO₂ and older age are significant correlates for a low cHCVR in men. For women only, BMI was associated with cHCVR. These findings suggest that men and women may have different ventilatory control mechanisms.

Key Words: carbon dioxide • control of breathing • gender • obesity • obstructive sleep apnea

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