Skip to main content
SpringerLink
Log in

Investigating the Dynamics of Supine Fluid Redistribution Within Multiple Body Segments Between Men and Women

  • Published:
Annals of Biomedical Engineering Aims and scope Submit manuscript

Abstract

While supine, fluid moves from the legs and accumulates in the chest and neck. However, patterns of rostral fluid shift are not clear. Furthermore, real-time measurement of neck fluid volume has not been investigated. The objective of this study was to investigate the dynamics of rostral fluid shift in men and women. We developed a bioelectrical impedance system to measure leg, abdominal, thoracic and neck fluid volumes (LFV, AFV, TFV, NFV) continuously. Forty healthy non-obese adults (20 men) lay supine for 90 min while fluid volumes were measured. After 90 min, a similar volume of fluid shifted out of the legs in both sexes (p = 0.079), but men accumulated more fluid in their thorax (63 ± 6 vs. 44 ± 11 ml, p = 0.016) and neck (17 ± 2 vs. 14 ± 1 ml, p = 0.029) than women. In both sexes, the increase in NFV caused a significant increase in neck circumference, which was greater in men (p = 0.009). Furthermore, 80% of rostral fluid shift would occur in the first 2 h of lying supine. These results suggest that greater fluid shift into the thorax and neck may contribute to the higher prevalence of sleep apnea in men than in women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

Abbreviations

AFV:

Abdominal fluid volume

ANCOVA:

Analysis of covariance

BMI:

Body mass index

LFV:

Leg fluid volume

NC:

Neck circumference

NFV:

Neck fluid volume

TFV:

Thoracic fluid volume

UA-XSA:

Upper airway cross-sectional area

References

  1. Avasthey, P., and E. H. Wood. Intrathoracic and venous pressure relationships during responses to changes in body position. J. Appl. Physiol. 37:166–175, 1974.

    CAS  PubMed  Google Scholar 

  2. Baccelli, G., P. Pacenti, S. Terrani, M. Checchini, G. Riglietti, F. Prestipino, E. Omboni, F. Sardella, M. Catalano, and Z. Malacarne. Scintigraphic recording of blood volume shifts. J. Nucl. Med. 36:2022–2031, 1995.

    CAS  PubMed  Google Scholar 

  3. Berg, H. E., B. Tedner, and P. A. Tesch. Changes in lower limb muscle cross-sectional area and tissue fluid volume after transition from standing to supine. Acta Physiol. Scand. 148:379–385, 1993.

    Article  CAS  PubMed  Google Scholar 

  4. Bracco, D., D. Thiebaud, R. L. Chiolero, M. Landry, P. Burckhardt, and Y. Schutz. Segmental body composition assessed by bioelectrical impedance analysis and DEXA in humans. J. Appl. Physiol. (1985) 81:2580–2587, 1996.

    CAS  Google Scholar 

  5. Chiu, K. L., C. M. Ryan, S. Shiota, P. Ruttanaumpawan, M. Arzt, J. S. Haight, C. T. Chan, J. S. Floras, and T. D. Bradley. Fluid shift by lower body positive pressure increases pharyngeal resistance in healthy subjects. Am. J. Respir. Crit. Care Med. 174:1378–1383, 2006.

    Article  PubMed  Google Scholar 

  6. De Lorenzo, A., A. Andreoli, J. Matthie, and P. Withers. Predicting body cell mass with bioimpedance by using theoretical methods: a technological review. J. Appl. Physiol. (1985) 82:1542–1558, 1997.

    Google Scholar 

  7. Dempsey, J. A., S. C. Veasey, B. J. Morgan, and C. P. O’Donnell. Pathophysiology of sleep apnea. Physiol. Rev. 90:47–112, 2010.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Demura, S., S. Sato, and T. Kitabayashi. Percentage of total body fat as estimated by three automatic bioelectrical impedance analyzers. J. Physiol. Anthropol. Appl. Hum. Sci. 23:93–99, 2004.

    Article  Google Scholar 

  9. Drazner, M. H., A. Prasad, C. Ayers, D. W. Markham, J. Hastings, P. S. Bhella, S. Shibata, and B. D. Levine. The relationship of right- and left-sided filling pressures in patients with heart failure and a preserved ejection fraction. Circ. Heart Fail 3:202–206, 2010.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Fawcett, J. K., and V. Wynn. Effects of posture on plasma volume and some blood constituents. J. Clin. Pathol. 13:304–310, 1960.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Fenech, M., and M. Y. Jaffrin. Extracellular and intracellular volume variations during postural change measured by segmental and wrist-ankle bioimpedance spectroscopy. IEEE Trans. Biomed. Eng. 51:166–175, 2004.

    Article  PubMed  Google Scholar 

  12. Fredberg, J. J., M. E. Wohl, G. M. Glass, and H. L. Dorkin. Airway area by acoustic reflections measured at the mouth. J. Appl. Physiol. 48:749–758, 1980.

    CAS  PubMed  Google Scholar 

  13. Friedman, O., T. D. Bradley, C. T. Chan, R. Parkes, and A. G. Logan. Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension. Hypertension 56:1077–1082, 2010.

    Article  CAS  PubMed  Google Scholar 

  14. Friedman, O., T. D. Bradley, and A. G. Logan. Influence of lower body positive pressure on upper airway cross-sectional area in drug-resistant hypertension. Hypertension 61:240–245, 2013.

    Article  CAS  PubMed  Google Scholar 

  15. Hildebrandt, W., H. C. Gunga, J. Herrmann, L. Rocker, K. Kirsch, and J. Stegemann. Enhanced slow caudad fluid shifts in orthostatic intolerance after 24-h bed-rest. Eur. J. Appl. Physiol. Occup. Physiol. 69:61–70, 1994.

    Article  CAS  PubMed  Google Scholar 

  16. Jafari, B., and V. Mohsenin. Overnight rostral fluid shift in obstructive sleep apnea: does it affect the severity of sleep-disordered breathing? Chest 140:991–997, 2011.

    Article  PubMed  Google Scholar 

  17. Jaffrin, M. Y., and H. Morel. Body fluid volumes measurements by impedance: a review of bioimpedance spectroscopy (BIS) and bioimpedance analysis (BIA) methods. Med. Eng. Phys. 30:1257–1269, 2008.

    Article  PubMed  Google Scholar 

  18. Kachlik, D., V. Pechacek, V. Musil, and V. Baca. The venous system of the pelvis: new nomenclature. Phlebology 25:162–173, 2010.

    Article  CAS  PubMed  Google Scholar 

  19. Kasai, T., J. S. Floras, and T. D. Bradley. Sleep apnea and cardiovascular disease: a bidirectional relationship. Circulation 126:1495–1510, 2012.

    Article  PubMed  Google Scholar 

  20. Kasai, T., S. S. Motwani, D. Yumino, J. M. Gabriel, L. T. Montemurro, V. Amirthalingam, J. S. Floras, and T. D. Bradley. Contrasting effects of lower body positive pressure on upper airways resistance and partial pressure of carbon dioxide in men with heart failure and obstructive or central sleep apnea. J. Am. Coll. Cardiol. 61:1157–1166, 2013.

    Article  PubMed  Google Scholar 

  21. Kasai, T., S. S. Motwani, D. Yumino, S. Mak, G. E. Newton, and T. D. Bradley. Differing relationship of nocturnal fluid shifts to sleep apnea in men and women with heart failure. Circ. Heart Fail. 5:467–474, 2012.

    Article  PubMed  Google Scholar 

  22. Krogh, A., E. M. Landis, and A. H. Turner. The movement of fluid through the human capillary wall in relation to venous pressure and to the colloid osmotic pressure of the blood. J. Clin. Invest. 11:63–95, 1932.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Kyle U. G., I. Bosaeus, A. D. De Lorenzo, P. Deurenberg, M. Elia, J. M. Gomez, B. L. Heitmann, L. Kent-Smith, J. C. Melchior, M. Pirlich, H. Scharfetter, A. M. Schols, C. Pichard and E. W. G. Composition of the. Bioelectrical impedance analysis–part I: review of principles and methods. Clin. Nutr. 23:1226–1243, 2004.

  24. Larsen, F., L. Mogensen, and B. Tedner. Influence of furosemide and body posture on transthoracic electrical impedance in AMI. Chest 90:733–737, 1986.

    Article  CAS  PubMed  Google Scholar 

  25. Levick, J. R., and C. C. Michel. The effects of position and skin temperature on the capillary pressures in the fingers and toes. J. Physiol. 274:97–109, 1978.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Ling, C. H., A. J. de Craen, P. E. Slagboom, D. A. Gunn, M. P. Stokkel, R. G. Westendorp, and A. B. Maier. Accuracy of direct segmental multi-frequency bioimpedance analysis in the assessment of total body and segmental body composition in middle-aged adult population. Clin. Nutr. 30:610–615, 2011.

    Article  PubMed  Google Scholar 

  27. Malhotra, A., Y. Huang, R. B. Fogel, G. Pillar, J. K. Edwards, R. Kikinis, S. H. Loring, and D. P. White. The male predisposition to pharyngeal collapse: importance of airway length. Am. J. Respir. Crit. Care Med. 166:1388–1395, 2002.

    Article  PubMed  Google Scholar 

  28. Marin, J. M., S. J. Carrizo, E. Vicente, and A. G. Agusti. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053, 2005.

    Article  PubMed  Google Scholar 

  29. Mohapatra, S. N., and D. W. Hill. The changes in blood resistivity with haematocrit and temperature. Eur. J. Intensive Care Med. 1:153–162, 1975.

    Article  CAS  PubMed  Google Scholar 

  30. Mohsenin, V. Gender differences in the expression of sleep-disordered breathing : role of upper airway dimensions. Chest 120:1442–1447, 2001.

    Article  CAS  PubMed  Google Scholar 

  31. Punjabi, N. M., B. S. Caffo, J. L. Goodwin, D. J. Gottlieb, A. B. Newman, G. T. O’Connor, D. M. Rapoport, S. Redline, H. E. Resnick, J. A. Robbins, E. Shahar, M. L. Unruh, and J. M. Samet. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 6:e1000132, 2009.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Redolfi, S., I. Arnulf, M. Pottier, T. D. Bradley, and T. Similowski. Effects of venous compression of the legs on overnight rostral fluid shift and obstructive sleep apnea. Respir. Physiol. Neurobiol. 175:390–393, 2011.

    Article  PubMed  Google Scholar 

  33. Redolfi, S., I. Arnulf, M. Pottier, J. Lajou, I. Koskas, T. D. Bradley, and T. Similowski. Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency. Am. J. Respir. Crit. Care Med. 184:1062–1066, 2011.

    Article  PubMed  Google Scholar 

  34. Redolfi, S., D. Yumino, P. Ruttanaumpawan, B. Yau, M. C. Su, J. Lam, and T. D. Bradley. Relationship between overnight rostral fluid shift and Obstructive Sleep Apnea in nonobese men. Am. J. Respir. Crit. Care Med. 179:241–246, 2009.

    Article  PubMed  Google Scholar 

  35. Rowley, J. A., X. Zhou, I. Vergine, M. A. Shkoukani, and M. S. Badr. Influence of gender on upper airway mechanics: upper airway resistance and Pcrit. J. Appl. Physiol. 91(2248–2254):2001, 1985.

    Google Scholar 

  36. Ryan, C. M., and T. D. Bradley. Pathogenesis of obstructive sleep apnea. J. Appl. Physiol. 99:2440–2450, 2005.

    Article  PubMed  Google Scholar 

  37. Shepard, Jr, J. W., D. A. Pevernagie, A. W. Stanson, B. K. Daniels, and P. F. Sheedy. Effects of changes in central venous pressure on upper airway size in patients with obstructive sleep apnea. Am. J. Respir Crit. Care. Med. 153:250–254, 1996.

    Article  PubMed  Google Scholar 

  38. Shiota, S., C. M. Ryan, K. L. Chiu, P. Ruttanaumpawan, J. Haight, M. Arzt, J. S. Floras, C. Chan, and T. D. Bradley. Alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects. Thorax 62:868–872, 2007.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Singh B., A. Yadollahi, O. D. Lyons, H. Alshaer and T. D. Bradley. Measurement of leg fluid volume using bioelectrical impedance [abstract]. In: American Physiology Society Experimental Biology Conference. San Diego, CA, pp. 1156–1114, 2014.

  40. Starling, E. H. On the absorption of fluids from the connective tissue spaces. J. Physiol. 19:312–326, 1896.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Su, M. C., K. L. Chiu, P. Ruttanaumpawan, S. Shiota, D. Yumino, S. Redolfi, J. S. Haight, and T. D. Bradley. Lower body positive pressure increases upper airway collapsibility in healthy subjects. Respir. Physiol. Neurobiol. 161:306–312, 2008.

    Article  PubMed  Google Scholar 

  42. Su, M. C., K. L. Chiu, P. Ruttanaumpawan, S. Shiota, D. Yumino, S. Redolfi, J. S. Haight, B. Yau, J. Lam, and T. D. Bradley. Difference in upper airway collapsibility during wakefulness between men and women in response to lower-body positive pressure. Clin. Sci. (Lond.) 116:713–720, 2009.

    Article  Google Scholar 

  43. Tagliabue, A., A. Andreoli, M. Comelli, S. Bertoli, G. Testolin, G. Oriani, and A. De Lorenzo. Prediction of lean body mass from multifrequency segmental impedance: influence of adiposity. Acta Diabetol. 38:93–97, 2001.

    Article  CAS  PubMed  Google Scholar 

  44. Terada, N., and T. Takeuchi. Postural changes in venous pressure gradients in anesthetized monkeys. Am. J. Physiol. 264:H21–H25, 1993.

    CAS  PubMed  Google Scholar 

  45. Thompson, W. O., P. K. Thompson, and M. E. Dailey. The effect of posture upon the composition and volume of the blood in man. J. Clin. Invest. 5:573–604, 1928.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. van Lieshout, J. J., M. P. Harms, F. Pott, M. Jenstrup, and N. H. Secher. Stroke volume of the heart and thoracic fluid content during head-up and head-down tilt in humans. Acta Anaesthesiol. Scand. 49:1287–1292, 2005.

    Article  PubMed  Google Scholar 

  47. Waterfield, R. L. The effect of posture on the volume of the leg. J. Physiol. 72:121–131, 1931.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Waterfield, R. L. The effects of posture on the circulating blood volume. J. Physiol. 72:110–120, 1931.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. White, L. H., and T. D. Bradley. Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea. J. Physiol. 591:1179–1193, 2013.

    Article  PubMed Central  PubMed  Google Scholar 

  50. XITRON. HYDRA ECF/ICF (Model 4200), Bio-impedance spectrum analyzer, for measuring intracellular and extracellular fluid volumes. Operating manual San Diego, CA, USA: XITRON Technologies Inc, 2007.

  51. Youmans, J. B., H. S. Wells, D. Donley, D. G. Miller, and H. Frank. The effect of posture (standing) on the serum protein concentration and colloid osmotic pressure of blood from the foot in relation to the formation of edema. J. Clin. Invest. 13:447–459, 1934.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Young, T., M. Palta, J. Dempsey, J. Skatrud, S. Weber, and S. Badr. The occurrence of sleep-disordered breathing among middle-aged adults. N. Engl. J. Med. 328:1230–1235, 1993.

    Article  CAS  PubMed  Google Scholar 

  53. Yumino, D., S. Redolfi, P. Ruttanaumpawan, M. C. Su, S. Smith, G. E. Newton, S. Mak, and T. D. Bradley. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation 121:1598–1605, 2010.

    Article  PubMed  Google Scholar 

  54. Yumino, D., H. Wang, J. S. Floras, G. E. Newton, S. Mak, P. Ruttanaumpawan, J. D. Parker, and T. D. Bradley. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. J. Card. Fail. 15:279–285, 2009.

    Article  PubMed  Google Scholar 

  55. Zhu, F., M. K. Kuhlmann, P. Kotanko, E. Seibert, E. F. Leonard, and N. W. Levin. A method for the estimation of hydration state during hemodialysis using a calf bioimpedance technique. Physiol. Meas. 29:S503–S516, 2008.

    Article  CAS  PubMed  Google Scholar 

  56. Zhu, F., D. Schneditz, E. Wang, and N. W. Levin. Dynamics of segmental extracellular volumes during changes in body position by bioimpedance analysis. J. Appl. Physiol. 85(497–504):1998, 1985.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Health Network Toronto Rehabilitation Institute, Room 12-106, 550 University Ave., Toronto, ON, M5G 2A2, Canada

    Azadeh Yadollahi, B. Singh & T. Douglas Bradley

  2. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada

    Azadeh Yadollahi

  3. Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Canada

    T. Douglas Bradley

  4. Department of Medicine, University Health Network Toronto General Hospital, Toronto, Canada

    T. Douglas Bradley

Authors
  1. Azadeh Yadollahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Douglas Bradley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Azadeh Yadollahi.

Additional information

Associate Editor Zahra Moussavi oversaw the review of this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yadollahi, A., Singh, B. & Bradley, T.D. Investigating the Dynamics of Supine Fluid Redistribution Within Multiple Body Segments Between Men and Women. Ann Biomed Eng 43, 2131–2142 (2015). https://doi.org/10.1007/s10439-015-1264-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10439-015-1264-0

Keywords

Search

Navigation