Transcutaneous carbon dioxide during sleep-disordered breathing

• Transcutaneous CO2 (PtcCO2) measurement is sensitive to sleep-disordered breathing.
• Different sleep apnoea types are characterized by different PtcCO2 levels.
• Highest PtcCO2 levels are observed during inspiratory flow limitation sequences.

Respiratory drive is tightly controlled by the carbon dioxide levels. We tested the hypothesis that sequences of sleep apnoea (obstructive, central or mixed), hypopnoea and flow limitation are characterized by different levels of transcutaneous CO2 (PtcCO2). Polygraphic recordings (n = 555) from patients with suspected sleep-disordered breathing (SDB) were retrospectively screened to find sequences (5 min or 10 events) of both SDB and steady breathing. Eighty-eight SDB sequences from 44 patients were included and PtcCO2 and SpO2 values were collected. PtcCO2 values during sequences were normalized by setting wakefulness level as 100%. In terms of PtcCO2, apnoea sequences with central component (central (n = 7) and mixed (n = 3) apnoea) did not differ from wakefulness (102.0% vs 100%, p = 0.122) whereas obstructive apnoea (105.8%, p < 0.001) and hypopnoea did (105.4%, p < 0.001). PtcCO2 during flow limitation was higher than that during any other sequence, including steady breathing (112.2% vs 108.4%, p = 0.022). Continuous PtcCO2 monitoring during sleep adds to the understanding of different SDB phenotypes.