Developmental changes in response to subatmospheric pressure loading of the upper airway

1999 ◽  
Vol 87 (2) ◽  
pp. 626-633 ◽  
Author(s):  
Carole L. Marcus ◽  
Janita Lutz ◽  
Audrey Hamer ◽  
Philip L. Smith ◽  
Alan Schwartz
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Upper Airway ◽  
Pressure Loading ◽  
Subatmospheric Pressure ◽  
Pressure Flow ◽  
Ventilatory Drive ◽  
Upstream Pressure ◽  
Airway Responses ◽  
Upper Airway Structure

Children snore less than adults and have fewer obstructive apneas, suggesting a less collapsible upper airway. We therefore hypothesized that the compensatory upper airway responses to subatmospheric pressure loading decrease with age because of changes in upper airway structure and ventilatory drive. We measured upper airway upstream pressure-flow relationships during sleep in 20 nonsnoring, nonobese children and adults. Measurements were made by correlating maximal inspiratory airflow with the level of nasal pressure applied via a mask. The slope of the upstream pressure-flow curve ( SPF) was used to characterize upper airway function. We found that SPFwas flatter in children than in adults (8 ± 5 vs. 30 ± 18 ml ⋅ s−1⋅ cmH2O−1, P < 0.002) and that SPFcorrelated with age ( r = 0.62, P < 0.01) and body mass index ( r = 0.63, P < 0.01). The occlusion pressure in 100 ms during sleep was measured in six children and two adults; it correlated inversely with SPF( r = −0.80, P < 0.02). We conclude that the upper airway compensatory responses to subatmospheric pressure loading decrease with age. This is associated with increased body mass index, even in nonsnoring, nonobese subjects. Ventilatory drive during sleep plays a role in modulating upper airway responses.

Developmental changes in upper airway dynamics

2004 ◽  
Vol 97 (1) ◽  
pp. 98-108 ◽  
Author(s):  
Carole L. Marcus ◽  
Lucila B. Fernandes Do Prado ◽  
Janita Lutz ◽  
Eliot S. Katz ◽  
Cheryl A. Black ◽  
...  
Keyword(s):  
Upper Airway ◽  
Older Children ◽  
Normal Children ◽  
Compensatory Response ◽  
Pharyngeal Airway ◽  
Ventilatory Drive ◽  
Airway Response ◽  
Airway Responses ◽  
Airway Dynamics ◽  
Normal Adults

Normal children have a less collapsible upper airway in response to subatmospheric pressure administration (PNEG) during sleep than normal adults do, and this upper airway response appears to be modulated by the central ventilatory drive. Children have a greater ventilatory drive than adults. We, therefore, hypothesized that children have increased neuromotor activation of their pharyngeal airway during sleep compared with adults. As infants have few obstructive apneas during sleep, we hypothesized that infants would have an upper airway that was resistant to collapse. We, therefore, compared the upper airway pressure-flow (V̇) relationship during sleep between normal infants, prepubertal children, and adults. We evaluated the upper airway response to 1) intermittent, acute PNEG (infants, children, and adults), and 2) hypercapnia (children and adults). We found that adults had a more collapsible upper airway during sleep than either infants or children. The children exhibited a vigorous response to both PNEG and hypercapnia during sleep ( P < 0.01), whereas adults had no significant change. Infants had an airway that was resistant to collapse and showed a very rapid response to PNEG. We conclude that the upper airway is resistant to collapse during sleep in infants and children. Normal children have preservation of upper airway responses to PNEG and hypercapnia during sleep, whereas responses are diminished in adults. Infants appear to have a different pattern of upper airway activation than older children. We speculate that the pharyngeal airway responses present in normal children are a compensatory response for a relatively narrow upper airway.

scholarly journals Polysomnographic and clinical characteristics of positional obstructive sleep apnea patients

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Seda Beyhan Sagmen ◽  
Sevda Cömert
Keyword(s):  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Body Mass ◽  
Severe Disease ◽  
Upper Airway ◽  
Neck Circumference ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
The Mean

Abstract Background Obstructive sleep apnea is a condition characterized by the complete or partial obstruction of the upper airway during sleep. This study aimed to compare the clinical and polysomnographic characteristics of our obstructive sleep apnea patients according to their positional and non-positional features. Results Two hundred eighty patients were included in the study. One hundred two patients (36.43%) were female, while 178 patients (63.57%) were male. While 88 (31.43%) of these patients were defined as positional patients, 192 (68.57%) were defined as non-positional patients. The mean age of the positional patients (46.78 ± 9.66) was lower than the mean age of the non-positional patients (50.90 ± 10.96) (p 0.001). Similarly, the mean body mass index of the positional patients (29.39 ± 3.80) was lower than the mean body mass index of the non-positional patients (33.30 ± 6.45) (p < 0.001). Neck circumference values of the positional patients (40.36 ± 2.65) were lower compared to the non-positional patients (43.32 ± 2.54) (p < 0.001). Sleep values were compared based on the presence of positional sleep apnea. In the positional patients, sleep duration, sleep efficiency (percentage), duration of stage N3, minimum, and mean saturation values were found to be higher compared to the non-positional patients, while nightlong apnea hypopnea index, apnea index, percentage of sleep time with oxygen saturation below 90%, oxygen desaturation index, mean heart rate, and periodic limb movement index values were found to be lower (p < 0.05). The rate of severe sleep apnea (7.95%) in the positional patients was lower than the non-positional patients (53.65%) (p < 0.001). Conclusion In the light of these data, positional OSA is a very important condition presented in 31.43% of OSA patients and it was determined that these patients were younger, had less body mass index, and shorter neck circumference. The rate of severe disease was found to be lower in positional OSA patients

Upper Airway Stimulation in Patients With Obstructive Sleep Apnea and an Elevated Body Mass Index: A Multi-institutional Review

2018 ◽  
Vol 128 (10) ◽  
pp. 2425-2428 ◽  
Author(s):  
Colin Huntley ◽  
Armin Steffen ◽  
Karl Doghramji ◽  
Benedikt Hofauer ◽  
Clemens Heiser ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Body Mass ◽  
Upper Airway ◽  
Upper Airway Stimulation ◽  
Elevated Body Mass Index ◽  
Institutional Review ◽  
Obstructive Sleep

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.

Impact of Body Mass Index and Discomfort on Upper Airway Stimulation: ADHERE Registry 2020 Update

2021 ◽  
Author(s):  
Maria V. Suurna ◽  
Armin Steffen ◽  
Maurits Boon ◽  
Eugene Chio ◽  
Marcel Copper ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Upper Airway ◽  
Upper Airway Stimulation

scholarly journals Cephalometrics of Pharyngeal Airway Space in Lebanese Adults

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Antoine Daraze ◽  
Myriam Delatte ◽  
Giuseppe Liistro ◽  
Zeina Majzoub
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Upper Airway ◽  
Posterior Pharyngeal Wall ◽  
Neck Circumference ◽  
Anthropometric Parameters ◽  
Pharyngeal Wall ◽  
Skeletal Class ◽  
Pharyngeal Airway ◽  
Lateral Cephalograms

Purpose. The upper airway space is significant in orthodontic diagnosis and treatment planning. The objectives of this study are to assess the dimensions of soft tissue elements of the upper pharyngeal space and evaluate potential correlations with modifying variables such as gender, skeletal class, and anthropometric parameters.Materials and Methods. Lateral cephalograms were obtained from 117 healthy young adult Lebanese subjects. Nineteen cephalometric linear/angular measurements of the nasopharynx, oropharynx, and hypopharynx were recorded. Anthropometric parameters including body mass index and neck circumference were measured.Results. Significant differences were demonstrated for 12 out of the 19 parameters considered between genders. Uvula and tongue dimensions and the distances between epiglottis-posterior pharyngeal wall and epiglottis-posterior nasal spine were significantly larger in males. The anteroposterior inclination of the uvula and the distances between the uvula and posterior pharyngeal wall were significantly greater in females. No significant differences were found between skeletal classes relative to most of the variables. Body mass index and neck circumference were positively correlated with the dimensions of tongue and uvula.Conclusions. Sexual dimorphism relative to some cephalometric variables and anthropometric parameters may account partly for larger oronasopharyngeal spaces in females. Anthropometric data need to be accounted for in population-related comparisons.

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 The Evaluation of Upper Airway: Point of Care Ultrasound vs. Conventional Tests

2019 ◽  
Vol 6 (12) ◽  
pp. 321-326
Author(s):  
Burak Yıldız ◽  
Banu Çevik ◽  
Yılmaz Karaduman ◽  
Özlem Sezen ◽  
Kemal Tolga Saraçoğlu
Keyword(s):  
Body Mass Index ◽  
Difficult Airway ◽  
Body Mass ◽  
Elective Surgery ◽  
Point Of Care ◽  
Preoperative Evaluation ◽  
Upper Airway ◽  
Point Of Care Ultrasound ◽  
Distance Ratio ◽  
Index Value

Objective: The ultrasound-guided interventions have gained widespread popularity in several aspects of anesthesia practice. In this study, we aimed to compare the preoperative evaluation tests and sonographic measurements of the upper airway for the prediction of a potentially difficult airway. Material and Methods: In this prospective observational study, we enrolled 136 adult patients undergoing elective surgery under general anesthesia. The Modified Mallampati classification, thyromental distance, sternomental distance, and Cormack-Lehane scores were recorded. Sonographic measurements included pre-epiglottic space (PES), the distance between the midpoints of vocal cords and epiglottis (EVC). The ratio was interpreted. Main outcome is to determine the sensitivity and specificity of the upper airway ultrasound for the prediction of a potentially difficult airway. Results: There was no statistically significant relationship between body mass index value and thyromental distance, Thyromental/Sternomental Ratio and PES/EVC ratio, Cormack-Lehane, Mallampati classification and thyromental/sternomental distance ratio (p>0.05). The sonographic measurements of airway have no significance to predict the difficult intubation and the comparison between PES, EVC and the PES/EVC ratio and assessment tests (Cormack-Lehane, Mallampati classification, thyromental and sternomental distances) was insignificant. The sternomental distance measurement was predictive for the difficult airway only in patients having body mass index more than 31.6 kg m-2. Conclusion: Ultrasound is a useful tool for identifying the upper airway prior to anesthesia but the validity for the prediction of difficult airway is not clear. By increasing the clinical experiences and further investigations, a greater insight into its use will be gained.

Glottic and cervical tracheal narrowing in patients with obstructive sleep apnea

1989 ◽  
Vol 67 (6) ◽  
pp. 2427-2431 ◽  
Author(s):  
I. Rubinstein ◽  
T. D. Bradley ◽  
N. Zamel ◽  
V. Hoffstein
Keyword(s):  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Body Mass ◽  
Upper Airway ◽  
The Body ◽  
Apnea Hypopnea Index ◽  
Structural Abnormality ◽  
Pathophysiological Mechanism ◽  
Obstructive Sleep

There are several studies showing that patients with idiopathic obstructive sleep apnea (OSA) have a narrow and collapsible pharynx that may predispose them to repeated upper airway occlusions during sleep. We hypothesized that this structural abnormality may also extend to the glottic and tracheal region. Consequently, we measured pharyngeal (Aph), glottic (Agl), cervical tracheal (Atr1), midtracheal (Atr2), and distal (Atr3) tracheal areas during tidal breathing in 66 patients with OSA (16 nonobese and 50 obese) and 8 nonapneic controls. We found that Aph, Agl, and Atr1, but not Atr2 or Atr3, were significantly smaller in the OSA group than in the control group. Obese patients with OSA had the smallest upper airway area, although the nonapneic controls had the largest areas. Multiple linear regression analysis revealed that the pharyngeal area, cervical tracheal area, and body mass index were all independent determinants of the apnea-hypopnea index, accounting for 31% of the variability in apnea-hypopnea index. Aph, Agl, and Atr showed significant correlation with the body mass index. We conclude that sleep-disordered breathing is associated with diffuse upper airway narrowing and that obesity contributes to this narrowing. Furthermore, we speculate that a common pathophysiological mechanism may be responsible for this reduction in upper airway area extending from the pharynx to the proximal trachea.

Upper Airway Stimulation Response in Older Adults with Moderate to Severe Obstructive Sleep Apnea

2019 ◽  
Vol 161 (4) ◽  
pp. 714-719 ◽  
Author(s):  
Kirk Withrow ◽  
Sean Evans ◽  
John Harwick ◽  
Eric Kezirian ◽  
Patrick Strollo
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Body Mass ◽  
Epworth Sleepiness Scale ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Upper Airway Stimulation ◽  
Younger Adults ◽  
Obstructive Sleep ◽  
The Impact

Objective To evaluate the impact of age on safety, efficacy, and usage of upper airway stimulation (UAS). Study Design Multicenter observational study. Setting Thirteen US hospitals and 3 German hospitals. Subjects and Methods The ADHERE registry is a multicenter database enrolling patients undergoing UAS implantation from October 2016 to April 2018. Outcome measures included the Epworth Sleepiness Scale, apnea-hypopnea index (AHI), therapy usage, and complications. Data were segmented by age (<65 vs ≥65 years). Results Younger adults (n = 365) were a mean ± SD 52.7 ± 7.9 years old and 82% male, with a body mass index of 29.6 ± 3.8. Older adults (n = 235) were 71.1 ± 4.8 years old and 71% male, with a body mass index of 28.8 ± 3.8. Baseline AHI was similar (younger, 36.2 ± 15.9; older, 36.1 ± 14.8). Both groups had lower AHI at 12 months versus baseline ( P < .001), but the older group showed a greater reduction (7.6 ± 6.9 vs 11.9 ± 13.4, P = .01). The Epworth Sleepiness Scale score decreased from 12.3 ± 5.4 to 7.1 ± 4.8 ( P < .001) among younger adults and from 10.7 ± 5.7 to 6.3 ± 4.4 ( P < .001) among older adults. Usage was slightly higher among older adults (6.0 ± 2.0 vs 5.4 ± 2.1 hours/night, P = .02). Surgical time was similar between younger patients (2.4 ± 0.7 hours) and older patients (2.3 ± 0.7 hours, P = .40), with comparably low complications. Conclusion AHI reduction and therapy usage were found to be somewhat higher among patients aged ≥65 years who were treated with UAS. Surgical complications were low, in contrast to traditional sleep surgery.

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