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Respiratory physiology involves a complex interplay of elements including control of breathing, respiratory drive, pulmonary mechanics, distribution of ventilation and gas exchange. Body position may also play an important role in respiratory mechanics. While effective methods exist for measuring these variables, they are typically measured in isolation rather than in combination. In pulmonary disease, decreasing mechanical stress and strain and optimizing transpulmonary pressure or the distending pressure across the lung, minimizing overdistention and collapse are central to clinical management. Obesity has a significant impact on pulmonary mechanics and is a risk factor for obstructive sleep apnea (OSA). However, our understanding of these elements is limited even in the general population. The investigators plan to use various validated methods to assess control of breathing, respiratory drive, distribution of ventilation and gas exchange to obtain a better understanding of underlying physiologic signatures in patients with and without obesity and the role of posture/position, with a secondary analysis comparing participants with and without obstructive sleep apnea.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| BMI>24.9 kg/m2 |
| ||
| BMI 18-24.9 kg/m2 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Position change | Other | Distribution of ventilation, respiratory drive, pulmonary mechanics and gas exchange will be measured in 3 unique positions: prone, head of bed (HOB) flat (i.e. 0 degrees) and HOB elevated (i.e. 30 degrees). |
| Measure | Description | Time Frame |
|---|---|---|
| Distribution of ventilation | Change in regional ventilation distribution (ventral/dorsal) measured through electrical impedance tomography (EIT) | 3 hours |
| Respiratory drive | Respiratory drive differences will be measured by mean desaturation (change from baseline percent oxygen saturation) following breath-hold maneuvers | 3 hours |
| Respiratory drive | Respiratory drive differences will be assessed by the duration of maximal breath-hold (seconds) | 3 hours |
| Respiratory drive | Respiratory drive will also be assessed by measurement of occlusion pressure (cm H2O) at 100 ms (P0.1) after the initiation of an inspiratory effort against a closed circuit. | 3 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Pulmonary mechanics | Pulmonary mechanics will be measured by transpulmonary pressure (cmH2O)obtained from esophageal manometry (transpulmonary pressure= airway pressure- esophageal pressure) | 3 hours |
| Dead space fraction |
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Inclusion Criteria:
Exclusion Criteria:
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Investigators will enroll 20 subjects with BMI 18.5-24.9 and 20 subjects with BMI 25 or more. The detailed inclusion criteria for subjects are listed below.
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| Name | Affiliation | Role |
|---|---|---|
| Alex Pearce | University of California, San Diego | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California San Diego Health | La Jolla | California | 92037 | United States |
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| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D015619 | Respiratory System Abnormalities |
| D012131 | Respiratory Insufficiency |
| ID | Term |
|---|---|
| D012140 | Respiratory Tract Diseases |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D012120 | Respiration Disorders |
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Dead space fraction will be calculated by partial pressure arterial/transcutaneous CO2 (PCO2) minus partial pressure of CO2 in mixed expired gas divided by the partial pressure of arterial/transcutaneous CO2
| 3 hours |
| Ventilatory ratio | Ventilatory ratio will be calculated as measured minute ventilation multiplied by the measured partial pressure of PCO2 divided (transcutaneous) by the predicted minute ventilation based on ideal body weight multiplied by the ideal PaCO2 | 3 hours |