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Dr. Larramona Carrera was supported by BA08/90101 Instituto de Salud Carlos III, Ministry Science and Education of Spain and Fundacio Parc Tauli. Dr. Marcus was supported by NIH grants R01 HL58585 and UL1 RR024134. Philips Respironics, Inc. provided the airway pressure device. The other authors have indicated no financial conflicts of interest. This work was performed at The Children's Hospital of Philadelphia, Philadelphia, PA.

Analysis of institutional authors

Farre, RAuthorMontserrat, JmAuthor
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Article

Negative Expiratory Pressure Technique: An Awake Test to Measure Upper Airway Collapsibility in Adolescents

Publicated to:Sleep. 38 (11): 1783-1791 - 2015-11-01 38(11), DOI: 10.5665/sleep.5164

Authors: Larramona Carrera, Helena; Marcus, Carole L.; McDonough, Joseph M.; Oliva Morera, Joan C.; Huang, Jingtao; Farre, Ramon; Montserrat, Josep M.;

Affiliations

CIBER Enfermedades Resp, Madrid, Spain - Author
Fundacio Parc Tauli, Corporacio Sanitaria Parc Tauli, Sabadell, Spain - Author
Hosp Clin Barcelona, IDIBAPS, Lab Son, Pneumol, Barcelona, Spain - Author
Univ Barcelona, Fac Med, Unitat Biofis & Bioengn, IDIBAPS, Barcelona 7, Spain - Author
Univ Penn, Childrens Hosp Philadelphia, Sleep Ctr, Philadelphia, PA 19104 USA - Author
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Abstract

Upper airway (UA) collapsibility is a major pathophysiologic feature of the obstructive sleep apnea syndrome (OSAS). In adolescents, it is measured by obtaining the slope of pressure-flow relationship (SPF) while applying negative nasal pressure during sleep. An easier technique to assess UA collapsibility, consisting of application of negative expiratory pressure (NEP) during wakefulness, has demonstrated differences between control and OSAS subjects. We hypothesized that the NEP technique would correlate with SPF as a measurement of UA collapsibility in adolescents.During wakefulness, NEP of -5 cm H2O in the seated and supine position was applied during the first second of expiration. The area under the expiratory flow-volume curve during NEP was compared to tidal breathing (RatioNEP). In addition, adolescents underwent SPF measurements during sleep. Two SPF techniques were performed to measure the activated and relatively hypotonic UA.Pediatric sleep laboratory.Seven adolescents with OSAS and 20 controls.In the seated position, there was a correlation between RatioNEP and both hypotonic SPF (r = -0.39, P = 0.04) and activated SPF (r = -0.62, P = 0.001). In the supine position, there was a correlation between RatioNEP and activated SPF (r = -0.43, P = 0.03) and a trend for hypotonic SPF (r = -0.38, P = 0.06).The negative expiratory pressure (NEP) technique correlates with the hypotonic and activated slope of pressure-flow relationship measurements. The seated position showed the strongest correlation. The NEP technique can be used as an alternative method to evaluate upper airway collapsibility in adolescents.© 2015 Associated Professional Sleep Societies, LLC.

Keywords
adolescentschildrendevelopmental-changesdynamicsflow limitationgenioglossus activitynegative expiratory pressure techniqueobesityobstructive sleep apnea syndromesnorersvaluesvolumeAdolescentsChildrenDevelopmental-changesDynamicsFlow limitationGenioglossus activityNegative expiratory pressure techniqueObesityObstructive sleep apnea syndromeObstructive sleep-apneaSnorersUpper airway collapsibilityValuesVolume

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Sleep due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2015, it was in position 24/193, thus managing to position itself as a Q1 (Primer Cuartil), in the category Clinical Neurology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.79. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Field Citation Ratio (FCR) from Dimensions: 2.06 (source consulted: Dimensions Apr 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-04-30, the following number of citations:

  • WoS: 52
  • Scopus: 8
  • Europe PMC: 4
  • OpenCitations: 9
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-04-30:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 31.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 31 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 7.

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (Montserrat Canal, Josep M.).