Upper airway morphological changes in obstructive sleep apnoea: effect of age on pharyngeal anatomy

2020 ◽  
Vol 134 (4) ◽  
pp. 354-361
Author(s):  
F Gao ◽  
Y R Li ◽  
W Xu ◽  
Y S An ◽  
H J Wang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Airway Morphology

AbstractObjectiveTo evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea.MethodsA total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed.ResultsSoft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2.ConclusionA number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.

Airway changes in obstructive sleep apnoea patients associated with a supine versus an upright position examined using cone beam computed tomography

2014 ◽  
Vol 128 (9) ◽  
pp. 824-830 ◽  
Author(s):  
M Camacho ◽  
R Capasso ◽  
S Schendel
Keyword(s):  
Computed Tomography ◽  
Obstructive Sleep Apnoea ◽  
Cone Beam Computed Tomography ◽  
Sleep Apnoea ◽  
Upright Position ◽  
Cross Sectional Area ◽  
Cone Beam ◽  
Sectional Area ◽  
Cross Sectional ◽  
Obstructive Sleep

AbstractObjective:This study aimed to describe total volume and cross-sectional area measurement changes in obstructive sleep apnoea patients associated with a supine versus an upright position.Method:A retrospective chart review of patients who underwent cone beam computed tomography in upright and supine positions was performed, and the images were analysed.Results:Five obstructive sleep apnoea patients (all male) underwent both upright and supine cone beam computed tomography imaging. Mean age was 35.0 ± 9.3 years, mean body mass index was 28.1 ± 2.7 kg/m2 and mean apnoea–hypopnoea index was 39.3 ± 23.0 per hour. The airway was smaller when patients were in a supine compared with an upright position, as reflected by decreases in the following airway measurements: total volume; posterior nasal spine, uvula tip, retrolingual and tongue base (not significant) cross-sectional areas; and site of the minimum cross-sectional area (of the overall airway). Total airway volume decreased by 32.6 per cent and cross-sectional area measurements decreased between 32.3 and 75.9 per cent when patients were in a supine position.Conclusion:In this case series, the airway of obstructive sleep apnoea patients was significantly smaller when patients were in a supine compared with an upright position.

scholarly journals Beyond uvulopalatopharyngoplasty for obstructive sleep apnoea: single surgeon case series of contemporary airway reconstruction

2013 ◽  
Vol 127 (12) ◽  
pp. 1184-1189 ◽  
Author(s):  
S G MacKay ◽  
N Jefferson ◽  
N S Marshall
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Obstructive Sleep Apnoea ◽  
Case Series ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Post Surgery ◽  
Obstructive Sleep ◽  
Severity Scores ◽  
Airway Reconstruction

AbstractObjective:Adult patients with obstructive sleep apnoea can be a therapeutic surgical challenge if other treatments fail or are rejected. We report the outcomes of a series of 17 patients for whom standard device-based treatments failed or could not be used. These patients were considered unsuitable for a lesser operation and therefore underwent multilevel upper airway reconstruction.Method:Data from 17 consecutive patients were collected prospectively. This included pre- and post-surgery findings for clinical assessments, body mass index, sleep questionnaires, and laboratory polysomnograms. Patients underwent a combination of modified uvulopalatopharyngoplasty, transpalatal advancement and various tongue reduction procedures.Results:Analyses revealed statistically and clinically significant reductions in: mean apnoea-hypopnoea index scores (from 36.3 pre-operatively to 14.5 post-operatively,p < 0.001), mean Epworth sleepiness scale scores (from 11.3 to 5.3,p < 0.001) and mean snoring severity scores (from 6.9 to 1.3,p < 0.001). Body mass index remained unchanged.Conclusion:Multilevel upper airway reconstructive surgery was associated with large reductions in both objective and patient-centred subjective measures of obstructive sleep apnoea severity.

scholarly journals A retrospective study: does upper airway morphology differ between non-positional and positional obstructive sleep apnea?

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3918 ◽  
Author(s):  
Xiao Jiao ◽  
Jianyin Zou ◽  
Suru Liu ◽  
Jian Guan ◽  
Hongliang Yi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Retrospective Study ◽  
Sleep Apnea ◽  
Soft Palate ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Airway Morphology

Objective The objective of this study was to explore the differences in upper airway morphology between positional (POSA) and non-positional (NPOSA) obstructive sleep apnea. Methods This retrospective study enrolled 75 patients (45 NPOSA and 30 POSA) who underwent polysomnography (PSG) and computed tomography (CT). The differences in, and relationships of, the PSG values and CT data between POSA and NPOSA were analyzed. Results Significant (p < 0.05) differences between the two groups were found in the apnea/hypopnea index (AHI), lateral-AHI (L-AHI), soft palate length (SPL), cross-sectional palatopharyngeal area, and the coronal diameter (CD) of the palatopharyngeal area at the narrowest part of the glossopharynx, which were all higher in POSA, except for SPL, AHI, and L-AHI. L-AHI was correlated with the cross-sectional area (r =  − 0.306, p = 0.008) and CD (r =  − 0.398, p < 0.001) of the palatopharyngeal area, the cross-sectional area (r =  − 0.241, p = 0.038) and CD (r =  − 0.297, p = 0.010) of the narrowest level of the glossopharynx, the CD of the glossopharynx (r = 0.284, p = 0.013), body mass index (BMI, r = 0.273, p = 0.018), SPL (r = 0.284, p = 0.014), and vallecula-tip of tongue (r = 0.250, p = 0.030). The SPL and CD at the narrowest part of the glossopharynx were included in the simplified screening model. Conclusions In NPOSA, the CD of the upper airway was smaller, and the soft palate was longer, than in POSA. These differences may play significant roles in explaining the main differences between NPOSA and POSA.

scholarly journals BASAN index (Body mass index, Age, Sex, Arterial hypertension and Neck circumference) predicts severe apnoea in adults living at high altitude

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044228
Author(s):  
Henry Oliveros ◽  
Rafael Lobelo ◽  
Luis Fernando Giraldo-Cadavid ◽  
Alirio Bastidas ◽  
Constanza Ballesteros ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Arterial Hypertension ◽  
High Altitude ◽  
Body Mass ◽  
Sleep Apnoea ◽  
Neck Circumference ◽  
Binary Logistic Regression Model ◽  
Cross Sectional ◽  
Derivation Cohort ◽  
Obstructive Sleep

ObjectivesObstructive sleep apnoea (OSA)/hypopnoea syndrome is associated with serious and major multiorgan morbidities, particularly in its most severe forms. However, no severe OSA screening instruments are available for high altitude residents that enable adequate identification and clinical prioritisation of such patients. We aimed at developing a severe OSA prediction tool based on the clinical characteristics and anthropometric measurements of a clinical referral cohort living at 2640 m.a.s.l.DesignCohort-nested cross-sectional study.SettingSleep laboratory for standard polysomnography (PSG) in Colombia.ParticipantsA predictive model was generated from 8718 participants referred to the PSG laboratory. Results were subsequently validated in a second cohort of 1898 participants.Primary outcomeTo identify clinical and anthropometric variables associated with severe OSA (>30 events/hour) and to include them in a binary logistic regression model.ResultsThe significant variables that were retained with the presence of severe OSA included Body mass index (BMI), Age, Sex, Arterial hypertension and Neck circumference (BASAN). The area under the receiver operating characteristic curvefor the BASAN index was 0.69 (95% CI: 0.68 to 0.70) in the derivation cohort and 0.67 (95% CI: 0.65 to 0.69) in the validation cohort, whereby a BASAN index ≥2 had a sensitivity of 95% and a specificity of 17% to detect severe OSA.ConclusionAn objectively based approach to screen for the presence of severe OSA, the BASAN index, exhibits favourable sensitivity characteristics that should enable its operational use as a screening tool in a Hispanic population with a clinical suspicion of OSA and living at high altitude.

Upper Airway Effective Compliance during Wakefulness and Sleep in Obese Adolescents Studied via 2-Dimensional Dynamic MRI and Semi-automated Image Segmentation

2021 ◽  
Author(s):  
Kok Ren Choy ◽  
Sanghun Sin ◽  
Yubing Tong ◽  
Jayaram K. Udupa ◽  
Dirk M. Luchtenburg ◽  
...  
Keyword(s):  
Upper Airway ◽  
Dynamic Mri ◽  
Cross Sectional Area ◽  
Apnea Hypopnea Index ◽  
Morphological Operations ◽  
Sectional Area ◽  
Cross Sectional ◽  
Automated Method ◽  
Obstructive Sleep ◽  
Effective Compliance

Novel biomarkers of upper airway biomechanics may improve diagnosis of Obstructive Sleep Apnea Syndrome (OSAS). Upper airway effective compliance (EC), the slope of cross-sectional area versus pressure estimated using computational fluid dynamics (CFD), correlates with apnea-hypopnea index (AHI) and critical closing pressure (Pcrit). The study objectives are to develop a fast, simplified method for estimating EC using dynamic MRI and physiological measurements, and to explore the hypothesis that OSAS severity correlates with mechanical compliance during wakefulness and sleep. Five obese children with OSAS and five obese control subjects age 12-17 underwent anterior rhinomanometry, polysomnography and dynamic MRI with synchronized airflow measurement during wakefulness and sleep. Airway cross-section in retropalatal and retroglossal section images was segmented using a novel semi-automated method that uses optimized singular-value decomposition (SVD) image filtering and k-means clustering combined with morphological operations. Pressure was estimated using rhinomanometry Rohrer coefficients and flow rate, and EC calculated from the area-pressure slope during five normal breaths. Correlations between apnea-hypopnea index (AHI), EC, and cross-sectional area (CSA) change were calculated using Spearman rank correlation. The semi-automated method efficiently segmented the airway with average Dice Coefficient above 89% compared to expert manual segmentation. AHI correlated positively with EC at the retroglossal site during sleep (rs=0.74, p=0.014), and with change of EC from wake to sleep at the retroglossal site (rs=0.77, p=0.01). CSA change alone did not correlate significantly with AHI. EC, a mechanical biomarker which includes both CSA change and pressure variation, is a potential diagnostic biomarker for studying and managing OSAS.

scholarly journals Effect of ventilation therapy on mortality rate among obesity hypoventilation syndrome and obstructive sleep apnoea patients

2020 ◽  
Vol 6 (2) ◽  
pp. 00101-2019 ◽  
Author(s):  
Hanna-Riikka Kreivi ◽  
Tuomas Itäluoma ◽  
Adel Bachour
Keyword(s):  
Body Mass Index ◽  
Mortality Rate ◽  
Body Mass ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Control Group ◽  
Obesity Hypoventilation Syndrome ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

IntroductionThe prevalence of obesity is continually increasing worldwide, which increases the incidence of obesity hypoventilation syndrome (OHS) and its consequent mortality.MethodsWe reviewed the therapy mode, comorbidity and mortality of all OHS patients treated at our hospital between 2005 and 2016. The control group consisted of randomly selected patients with obstructive sleep apnoea (OSA) treated during the same period.ResultsWe studied 206 OHS patients and 236 OSA patients. The OHS patients were older (56.3 versus 52.3 years, p<0.001) and heavier (body mass index 46.1 versus 32.2 kg·m−2, p<0.001), and the percentage of women was higher (41.2% versus 24.2%, p<0.001), respectively. The OHS patients had more hypertension (83% versus 61%, p<0.001) and diabetes (62% versus 31%, p<0.001) than the OSA patients, but no higher stroke (4% versus 8%, p=0.058) or ischaemic heart disease (14% versus 15%, p=0.437) incidence. The 5- and 10-year, unadjusted survival rates were lower among the OHS patients than among the OSA patients (83% versus 96% and 74% versus 91%, respectively; p<0.001). Differences in mortality rates were not related to age, sex or body mass index; covariates such as Charlson Comorbidity Index and ventilation therapy predicted survival. The mortality rate decreased significantly (p<0.001) both in OHS and OSA patients even after adjusting for covariates.ConclusionsThe mortality rate in OHS was significantly higher than that in OSA patients even after adjusting for covariates. Ventilation therapy by continuous positive airway pressure or noninvasive ventilation have reduced mortality significantly in all patients.

158. Median nerve cross-sectional area in adults per body mass index

2012 ◽  
Vol 123 (6) ◽  
pp. e62
Author(s):  
C. Gutierrez ◽  
R.N. Sembrano ◽  
A. Ivanescu ◽  
M. Carrion-Jones ◽  
D. Moore
Keyword(s):  
Body Mass Index ◽  
Median Nerve ◽  
Body Mass ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional

scholarly journals Correlation of body mass index and pulmonary hypertension in patients with obstructive sleep apnoea

2021 ◽  
Vol 8 (2) ◽  
pp. 79-82
Author(s):  
Saurabh Mishra ◽  
G N Srivastava ◽  
J K Mishra ◽  
Ritamvara Oli
Keyword(s):  
Body Mass Index ◽  
Pulmonary Hypertension ◽  
Body Mass ◽  
Obstructive Sleep Apnoea ◽  
Severe Obesity ◽  
Strong Association ◽  
Sleep Apnoea ◽  
Cardiac Anomaly ◽  
2D Echocardiography ◽  
Obstructive Sleep

Obstructive sleep apnoea has very strong association with both body mass index and pulmonary hypertension. There is a paucity of data to relate BMI and PH in patients with OSA. To see the relation between body mass index and pulmonary hypertension in patients with obstructive sleep apnoea. Patients with symptoms of OSA were screened for polysomnography by using STOP-BANG criteria. 100 patients with AHI ≥5 with symptoms of obstructive sleep apnoea and AHI ≥ 15 without symptoms of obstructive sleep apnoea were selected for other investigations. Neck circumference was measured and BMI was calculated to estimate the severity of obstruction. PFT and chest X-ray were done to rule-out other respiratory illnesses. 2D-echocardiography was done for screening of pre-existing structural cardiac anomaly or any raise in pulmonary artery pressure. MRI neck was done to check neck muscles status. Out of 100 patients in study group 10% (n=10) had mild, 12% (n=12) had moderate and 78% (n=78) had severe OSA. Most of the patients belonged to overweight (52%) and obesity stage 1 (34%) groups. 10% and 2% of the patients belonged to obesity stage 2 and severe obesity groups respectively. Only 2% of the patients were healthy and none of the patients were underweight. PH was present in 24% (n=24) of cases, mild (n=10) and moderate (n=10) PH each were 10% and severe (n=4) PH was present in 4% of the cases. 100% of the patients with severe obesity had pulmonary hypertension. Most of the patients with PH belonged to Obesity grade 1 and overweight groups, whereas none of normal BMI patients had PH. Body mass index has indirect relation with pulmonary hypertension. In our study, we found that pulmonary hypertension was present only in overweight and obese patients. Whereas, none of the patients with normal BMI had pulmonary hypertension.

Retropalatal Cross-Sectional Area Is Predictive of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis

2019 ◽  
Vol 57 (5) ◽  
pp. 560-565 ◽  
Author(s):  
Cory M. Resnick ◽  
Jason K. Middleton ◽  
Carly E. Calabrese ◽  
Karan Ganjawalla ◽  
Bonnie L. Padwa
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Sectional Area ◽  
Cross Sectional ◽  
Syndromic Craniosynostosis ◽  
Obstructive Sleep

Objective: There is a high rate of obstructive sleep apnea (OSA) in patients with syndromic craniosynostosis (SCS). Little is known about the airway anatomy in this population. The purpose of this study is to characterize the 3 dimensional (3D) upper airway in patients with SCS with and without OSA. Design: This is a retrospective study of patients with SCS treated at Boston Children’s Hospital from 2000 to 2015. Patients were divided into OSA and no-OSA groups based on polysomnography. Predictor variables included age, sex, body mass index (BMI), and 3D upper airway measurements. The primary outcome variable was the presence or absence of OSA. Secondary outcome variables were apnea–hypopnea index and oxygen saturation nadir. Descriptive and bivariate statistics were computed, and significance was set as P < .05. Results: There were 24 patients: 16 in the OSA group and 8 in the no-OSA group. The 2 groups did not differ significantly by age, BMI, or syndromic diagnosis. The presence of OSA was associated with a smaller minimum retropalatal cross-sectional area (minRPCSA; P < .001). In a logistic regression model controlling for age, sex, and upper airway length, minRPCSA was the primary predictor of OSA ( P ≤ .002). Receiver operating characteristic analysis determined minRPCSA = 55.3 mm2 to be the optimal diagnostic threshold for OSA, with sensitivity = 100% and specificity = 87.5% ( P < .001). Conclusion: A minRPCSA ≤55.3 mm2 is predictive of the presence of OSA in patients with SCS.

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