Gender differences in upper airway compliance during NREM sleep: role of neck circumference

2002 ◽  
Vol 92 (6) ◽  
pp. 2535-2541 ◽  
Author(s):  
James A. Rowley ◽  
Carrie S. Sanders ◽  
Brian R. Zahn ◽  
M. Safwan Badr
Keyword(s):  
Gender Differences ◽  
Gender Difference ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Neck Circumference ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Significant Difference ◽  
Upper Airway Structure

It has been proposed that the gender difference in sleep apnea prevalence is related to gender differences in upper airway structure and function. We hypothesized that men would have smaller retropalatal cross-sectional area and higher compliance during sleep compared with women. Using upper airway imaging, we measured upper airway cross-sectional area and retropalatal compliance in wakefulness and non-rapid eye movement (NREM) sleep in 15 men and 15 women without sleep-disordered breathing. Cross-sectional area at the beginning of inspiration tended to be larger in men compared with women in both wakefulness [194.5 ± 21.3 vs. 138.8 ± 12.0 (SE) mm2] and NREM sleep (111.1 ± 17.6 vs. 83.3 ± 11.9 mm2; P = 0.058). There was no significant difference, however, after correction for body surface area. Retropalatal compliance also tended to be higher in men during both wakefulness (5.9 ± 1.4 vs. 3.1 ± 1.4 mm2/cmH2O; P = 0.006) and NREM sleep (12.6 ± 2.7 vs. 4.7 ± 2.6 mm2/cmH2O; P = 0.055). However, compliance was similar in men relative to women after correction for neck circumference. We conclude that the gender difference in retropalatal compliance is more accurately attributed to differences in neck circumference between the genders.

A Simple Endoscopic Technique for Measuring the Cross-Sectional Area of the Upper Airway in a Rabbit Model

2018 ◽  
Vol 127 (4) ◽  
pp. 275-281 ◽  
Author(s):  
Paul R. Wistermayer ◽  
Wesley R. McIlwain ◽  
Nicholas Ieronimakis ◽  
Derek J. Rogers
Keyword(s):  
Rabbit Model ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Endoscopic Technique ◽  
Sectional Area ◽  
Cross Sectional ◽  
The Cross

Guideline Values for Minimum Nasal Cross-Sectional Area in Children

2018 ◽  
Vol 55 (8) ◽  
pp. 1043-1050
Author(s):  
Maija T. Laine-Alava ◽  
Siiri Murtolahti ◽  
Ulla K. Crouse ◽  
Donald W. Warren
Keyword(s):  
Cleft Lip ◽  
Cross Sectional Area ◽  
Adult Size ◽  
Nasal Airway ◽  
Sectional Area ◽  
Cross Sectional ◽  
Age Cohorts ◽  
Guideline Values ◽  
Significant Difference ◽  
Research Criteria

Objective: The purpose was to determine age-specific values of the minimum cross-sectional area of the nasal airway in children without cleft lip or palate and to assess whether gender differences occur with growth in order to develop guidelines for assessment in children with clefts. Participants: All schoolchildren aged 8 to 17 years who met the research criteria were studied during rest breathing using the pressure-flow technique. The children came from a rural area of 3800 inhabitants. Consecutive age cohorts were used for comparisons. Results: Nasal cross-sectional area increased in females from 0.38 cm2 in 8-year-olds to 0.58 cm2 in 17-year-olds. There was a decrease in size at ages 10 to 11 and 14 to 15 years. In males, the area increased from 0.40 to 0.68 cm2 and decreased slightly from 9 to 10 and 14 to 15 years. The annual changes were statistically significant in females between 8 and 9 and 11 to 13 years of age, and in males from 11 to 12, 13 to 14, and 15 to 17 years of age. Across gender, the only significant difference occurred at age 16. Conclusions: Our results indicate that the increase in nasal airway size is not consistent during growth. Nasal airway size showed almost equal values for both genders in young children but was systematically larger in boys from 14 years of age on. The results refer that by 17 years of age nasal airway may not have reached adult size in males.

Upper Airway 3D Changes of Patients With Cleft Lip and Palate After Orthognathic Surgery

2018 ◽  
Vol 56 (3) ◽  
pp. 314-320 ◽  
Author(s):  
Marilia Sayako Yatabe-Ioshida ◽  
Letícia Dominguez Campos ◽  
Renato Yassukata Yaedu ◽  
Ivy Kiemle Trindade-Suedam
Keyword(s):  
Orthognathic Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Class Iii ◽  
Linear Measurements ◽  
Cross Sectional ◽  
Skeletal Class

Objectives: The purpose of this study was to 3-dimensionally assess the airway characteristics of patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) who underwent orthognathic surgery. Design: This was a retrospective study. Setting: The study took place at a national referral center for cleft lip and palate rehabilitation. Patients and Participants: The sample comprised cone-beam computed tomography (CBCT) scans obtained before and after orthognathic surgery of 15 individuals (30 CBCT scans), divided into 2 groups: UCLP group (n = 9 patients/18 CBCT scans) and BCLP group (n = 6/12 CBCT scans). All patients had a nonsyndromic UCLP or BCLP and a skeletal class III malocclusion at the preoperative period. Interventions: Airway volume, pharyngeal minimal cross-sectional area (mCSA), location of mCSA, sella-nasion-A point (SNA) and sella-nasion-B point (SNB) angles, and condylion-A point and condyloid-gnathion linear measurements were assessed in open-source software (ITK-SNAP and SlicerCMF). Main Outcome Measure: Airway dimensions of patients with UCLP and BCLP increase after orthognathic surgery. Results: After orthognathic surgery, UCLP group showed a significant 20% increase in nasopharynx volume. Although not significant, BCLP group also showed an increase of 18% in the same region. Minimal cross-sectional area remained dimensionally stable after surgery and was all located in the oropharynx region, on both groups. Additionally, a positive correlation was observed between volume and mCSA on both groups. Conclusion: Overall, individuals with UCLP and BCLP showed an increase in the upper airway after orthognathic surgery and this might explain the breathing and sleep improvements reported by the patients after the surgery.

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.

Relevance of classification by size to topographical differences in bronchial smooth muscle response

1993 ◽  
Vol 75 (5) ◽  
pp. 2013-2021 ◽  
Author(s):  
P. Chitano ◽  
S. B. Sigurdsson ◽  
A. J. Halayko ◽  
N. L. Stephens
Keyword(s):  
Smooth Muscle ◽  
Electrical Field Stimulation ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Muscle Response ◽  
Bronchial Responsiveness ◽  
Sixth Generation ◽  
Significant Difference ◽  
And Control

To investigate heterogeneity of airway smooth muscle response, we studied strips of large and small branches from third- to sixth-generation bronchi obtained from ragweed antigen-sensitized and control dogs. The response to electrical field stimulation and carbamylcholine chloride was greater in strips from larger branches of the same generation when expressed as "tissue stress" (force per unit cross-sectional area of the whole tissue), whereas no difference emerged with use of the more appropriate "smooth muscle stress" (force per unit cross-sectional area of the muscle tissue). The response to histamine was significantly higher in small branches than in large ones, and histamine sensitivity [mean effective concentration (EC50)] was 7.79 x 10(-6) [geometric standard error of the mean (GSEM) 1.20] and 1.49 x 10(-5) M (GSEM 1.14), respectively (P < 0.01). Strips from control and sensitized animals at each site and strips from different generations did not show any significant difference. When we clustered our preparations according to dimensions, the response to histamine was significantly higher in small bronchi than in large ones and histamine EC50 was 8.95 x 10(-6) (GSEM 1.17) and 1.57 x 10(-5) M (GSEM 1.18), respectively (P < 0.05). We conclude that evaluation of muscle response in different tissues requires appropriate normalization. Furthermore, classification into generations is inadequate to study bronchial responsiveness, inasmuch as major differences originate from airway size.

The Effect of ACL Reconstruction on Involved and Contralateral Limb Vastus Lateralis Morphology and Histology: A Pilot Study

2019 ◽  
Author(s):  
Eric C. Leszczynski ◽  
Christopher Kuenze ◽  
Brett Brazier ◽  
Joseph Visker ◽  
David P. Ferguson
Keyword(s):  
Fiber Type ◽  
Vastus Lateralis ◽  
Knee Extension ◽  
Cross Sectional Area ◽  
Vastus Lateralis Muscle ◽  
Myosin Isoforms ◽  
Sectional Area ◽  
Cross Sectional ◽  
Contralateral Limb ◽  
Significant Difference

AbstractQuadriceps muscle weakness is a commonly reported issue post anterior cruciate ligament reconstruction (ACLR), with minimal information related to skeletal muscle morphology following surgery. The purpose is to examine the morphological and functional differences in the vastus lateralis muscle from patient's ACLR and contralateral leg. Three physically active ACLR participants were recruited and secured to a dynamometer to perform maximal voluntary isometric knee extension contractions (MVIC) of the ACLR and contralateral limb. Muscle biopsies of the ACLR and contralateral vastus lateralis were performed, then sectioned, and stained for myosin isoforms to determine fiber type. Confocal images were acquired, and ImageJ software was used to determine the fiber type and cross-sectional area (CSA). There was a significant reduction in CSA of the type IIa and type IIx muscle fiber cells between healthy (IIa: 7,718 ± 1,295 µm2; IIx; 5,800 ± 601 µm2) and ACLR legs (IIa: 4,139 ± 709 µm2; IIx: 3,708 ± 618 µm2) (p < 0.05), while there was no significant difference in knee extension MVIC torque between legs (healthy limb: 2.42 ± 0.52 Nm/kg; ACLR limb: 2.05 ± 0.24 Nm/kg, p = 0.11). The reduction in the cross-sectional area of the ACLR type II fibers could impair function and increase secondary injury risk.

scholarly journals Radiographic Analysis of Glenoid Morphology after Arthroscopic Latarjet vs Distal Tibial Allograft in the Treatment of Anterior Shoulder Instability

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009 ◽  
Author(s):  
Ivan H. Wong ◽  
JP King ◽  
Gordon Boyd ◽  
Michael Mitchell ◽  
Catherine M. Coady
Keyword(s):  
Shoulder Instability ◽  
Distal Tibia ◽  
Cross Sectional Area ◽  
Anterior Shoulder Instability ◽  
Sectional Area ◽  
Common Procedure ◽  
Cross Sectional ◽  
Significant Difference ◽  
Glenoid Reconstruction ◽  
Graft Resorption

Objectives: The Latarjet procedure for autograft transposition of coracoid to the anterior rim of the glenoid remains the most common procedure for reconstruction of the glenoid after shoulder instability. The anatomic glenoid reconstruction using distal tibial allograft has gained popularity and is suggested to better match the normal glenoid size and shape. However, there is concern for decreased healing and increased resorption using an allograft bone. The purpose of this study was to evaluate the arthroscopic reconstruction of the glenoid with respect to the size, shape, healing, and resorption of autograft coracoid vs allograft distal tibia. Methods: A retrospective review of 50 consecutive patients who had an arthroscopic boney reconstruction of the glenoid (13 coracoid; 37 distal tibial), diagnosed with anterior shoulder instability, and CT confirmed glenoid bone loss >20%. Pre-and post-operative CT scans were reviewed by two fellowship trained musculoskeletal radiologists for: graft position, glenoid concavity, cross sectional area, width, version, total area, osseous union, and graft resorption. Results: Graft nonunion was seen in 3 (23.07%) of the coracoid patients, and in 2 (5.4%) of the tibial allograft patients (OR 5.25; 95% CI: 0.768-35.89). Odds ratios comparing allograft to coracoid for overall resorption was 5.00 (CI: 1.276-19.597). Graft resorption greater than 50% was seen in 3 (8.11%) of the allografts and was absent within the coracoid patients. Graft resorption lesser than 50% was greater in both groups with 27 (72.97%) allograft and 6 (46.15%) coracoid patients. However, no statistically significant difference was found between the two procedures regarding AP diameter of graft (p=0.818) or graft cross sectional area (p=0.797). Conclusion: Arthroscopic anatomic glenoid reconstruction using distal tibial allograft showed greater boney union but higher resorption compared to coracoid autograft. Even so, there was no statistically significant difference between the two procedures regarding final graft surface area and size of grafts. These short-term results suggest distal tibial allograft as an alternative to coracoid autograft in the recreation of glenoid boney morphology.

Effect of position and lung volume on upper airway geometry

1987 ◽  
Vol 63 (1) ◽  
pp. 375-380 ◽  
Author(s):  
J. M. Fouke ◽  
K. P. Strohl
Keyword(s):  
Lung Volume ◽  
Supine Position ◽  
Upper Airway ◽  
Upright Position ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Position Change ◽  
Cross Sectional ◽  
Acoustic Reflection ◽  
Residual Capacity

The occurrence of upper airway obstruction during sleep and with anesthesia suggests the possibility that upper airway size might be compromised by the gravitational effects of the supine position. We used an acoustic reflection technique to image airway geometry and made 180 estimates of effective cross-sectional area as a function of distance along the airway in 10 healthy volunteers while they were supine and also while they were seated upright. We calculated z-scores along the airway and found that pharyngeal cross-sectional area was smaller in the supine than in the upright position in 9 of the 10 subjects. For all subjects, pharyngeal cross-sectional area was 23 +/- 8% smaller in the supine than in the upright position (P less than or equal to 0.05), whereas glottic and tracheal areas were not significantly altered. Because changing from the upright to the supine position causes a decrease in functional residual capacity (FRC), six of these subjects were placed in an Emerson cuirass, which was evacuated producing a positive transrespiratory pressure so as to restore end-expiratory lung volume to that seen before the position change. In the supine posture an increase in end-expiratory lung volume did not change the cross-sectional area at any point along the airway. We conclude that pharyngeal cross-sectional area decreases as a result of a change from the upright to the supine position and that the mechanism of this change is independent of the change in FRC.

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