scholarly journals State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea

2019 ◽  
Vol 45 (4) ◽  
Author(s):  
Ula Lindoso Passos ◽  
Pedro Rodrigues Genta ◽  
Bianca Fernandes Marcondes ◽  
Geraldo Lorenzi-Filho ◽  
Eloisa Maria Mello Santiago Gebrim
Keyword(s):  
Sleep Apnea ◽  
Multidetector Ct ◽  
Upper Airway ◽  
Control Group ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Airway Narrowing ◽  
Posterior Displacement ◽  
Waking And Sleep ◽  
Obstructive Sleep

ABSTRACT Objective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.

scholarly journals Much Ado about Sleep: Current Concepts on Mechanisms and Predisposition to Pediatric Obstructive Sleep Apnea

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1032
Author(s):  
Ashley L. Saint-Fleur ◽  
Alexa Christophides ◽  
Prabhavathi Gummalla ◽  
Catherine Kier
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Biomechanical Properties ◽  
Primary Role ◽  
Airway Narrowing ◽  
Airway Collapse ◽  
Upper Airway Collapse ◽  
Obstructive Sleep ◽  
Review Current

Obstructive Sleep Apnea (OSA) is a form of sleep-disordered breathing characterized by upper airway collapse during sleep resulting in recurring arousals and desaturations. However, many aspects of this syndrome in children remain unclear. Understanding underlying pathogenic mechanisms of OSA is critical for the development of therapeutic strategies. In this article, we review current concepts surrounding the mechanism, pathogenesis, and predisposing factors of pediatric OSA. Specifically, we discuss the biomechanical properties of the upper airway that contribute to its primary role in OSA pathogenesis and examine the anatomical and neuromuscular factors that predispose to upper airway narrowing and collapsibility.

scholarly journals Manipulation of Lateral Pharyngeal Wall Muscles in Sleep Surgery: A Review of the Literature

2020 ◽  
Vol 17 (15) ◽  
pp. 5315
Author(s):  
Giovanni Cammaroto ◽  
Luigi Marco Stringa ◽  
Giannicola Iannella ◽  
Giuseppe Meccariello ◽  
Henry Zhang ◽  
...  
Keyword(s):  
English Literature ◽  
Sleep Apnea Syndrome ◽  
Surgical Techniques ◽  
Upper Airway ◽  
Variable Degree ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Obstructive Sleep ◽  
Upper Airway Collapsibility ◽  
No Gold Standard

Background: Obstructive sleep apnea syndrome (OSAS) occurs due to upper airway obstruction resulting from anatomical and functional abnormalities. Upper airway collapsibility, particularly those involving the lateral pharyngeal wall (LPW), is known to be one of the main factors contributing to the pathogenesis of OSAS, leading the authors of the present study to propose different strategies in order to stiffen the pharyngeal walls to try to restore normal airflow. Methods: An exhaustive review of the English literature on lateral pharyngeal wall surgery for the treatment of OSAS was performed using the PubMed electronic database. Results: The research was performed in April 2020 and yielded approximately 2000 articles. However, considering the inclusion criteria, only 17 studies were included in the present study. Conclusions: The analyzed surgical techniques propose different parts of LPW on which to focus and a variable degree of invasivity. Despite the very promising results, no gold standard for the treatment of pharyngeal wall collapsibility has been proposed. However, thanks to progressive technological innovations and increasingly precise data analysis, the role of LPW surgery seems to be crucial in the treatment of OSAS patients.

Lateral pharyngeal wall collapse associated with hypoxemia in obstructive sleep apnea

2015 ◽  
Vol 125 (10) ◽  
pp. 2408-2412 ◽  
Author(s):  
Ming‐Chin Lan ◽  
Stanley Y. C. Liu ◽  
Ming‐Ying Lan ◽  
Rahul Modi ◽  
Robson Capasso
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Obstructive Sleep

247 EXTRACELLULAR MATRIX OF THE LATERAL PHARYNGEAL WALL IN NON-OBESE OBSTRUCTIVE SLEEP APNEA PATIENTS

2009 ◽  
Vol 10 ◽  
pp. S67
Author(s):  
D.A.S. Dantas ◽  
T. Mauad ◽  
L.F.F. Silva ◽  
G. Lorenzi-Filho ◽  
G.G.S. Formigoni ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Obstructive Sleep

Pulse Arterial Tone and Airway Obstruction in Sleep Apnea

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P83-P83 ◽  
Author(s):  
Jose E Barrera ◽  
Andrew B. Holbrook ◽  
Juan Santos ◽  
Gerald R Popelka
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Real Time ◽  
Upper Airway ◽  
Airway Narrowing ◽  
Obstructive Sleep ◽  
Airway Obstructions ◽  
Surgical Treatments ◽  
Arterial Tone ◽  
Continuous Pulse

Objective Determine if continuous pulse arterial tone (PAT) amplitude correlates with upper airway obstructions observed during simultaneous real-time magnetic resonance imaging (RT-MRI) in subjects with Obstructive Sleep Apnea (OSA). Methods A prospective series of 20 subjects diagnosed with mild to severe OSA by polysomnography, Fujita classification, Functional Outcomes of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Score (ESS) underwent continuous RT-MRI during a 90-minute nap without sedation. The upper airway at the mid-saggittal plane was visualized in real time (33 fps) using a sliding window algorithm (RTHawk system). Continuous pulse arterial tone amplitude was simultaneously monitored (Watch-PAT, Itamar Inc, Israel). Results Changes in PAT amplitude were in phase with upper airway narrowing and obstruction from tongue, soft palate, and epiglottis movements. Airway obstructive events occurred coincident to 60% or greater decreases in PAT amplitude. The image sequence associated with each PAT amplitude decrease demonstrated the precise location of the obstruction. Pre-surgical site of airway obstruction and post-surgical cause of persistent obstruction was clearly identified. Conclusions RT-MRI with simultaneous and continuous PAT signal recording during natural sleep is an innovative and improved method for more precisely characterizing airway obstructions in patients with mild to severe OSA. This approach may be valuable for planning surgical treatments, potentially improving the success of these procedures.

scholarly journals The Impact of Obstructive Sleep Apnea on Clinical, Perioperative, and Cost Outcomes in Patients Who Underwent Posterior Cervical Discectomy and Fusion: A Single Center Retrospective Analysis from 2008 to 2016

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Alejandro Carrasquilla ◽  
Dominic A Nistal ◽  
John M Caridi
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Regression Analyses ◽  
Cervical Discectomy ◽  
Prolonged Intubation ◽  
Airway Narrowing ◽  
Icu Admission ◽  
Obstructive Sleep ◽  
The Impact

Abstract INTRODUCTION Obstructive sleep apnea (OSA) is a chronic condition that results from upper airway narrowing during sleep, with an increasing prevalence estimated to be around 9% to 24%. The combination of an unstable, recently fused or immobile cervical spine and OSA may reasonably lead to special considerations, although this topic has not been well studied. METHODS We retrospectively obtained 1191 posterior cervical discectomy and fusion (PCDF) cases, of which 93 subjects (7.81%) had a history of OSA and 1098 subjects (92.19%) did not. The primary outcome selected was prolonged intubation. Secondary outcomes included intensive care unit (ICU) admission, overall complications, extended hospitalization, nonhome discharge, readmission within 30 and 90 d, emergency room visit within 30 and 90 d, and higher total costs. Univariate and multivariate logistic regression analyses were conducted to assess OSA-affected clinical and perioperative outcome measures. RESULTS Compared to the control cohort, the OSA cohort had more subjects with body mass index (BMI) >30 (P < .0001) and ASA status >2 (P < .0001). After controlling for age, sex, obesity, and ASA status, multivariate regression analyses revealed no difference in the odds of a prolonged intubation (P = .4092). However, a difference was noted in the odds of ICU admission (P = .0038), extended hospitalization (P = .0223), and nonhome discharge (P = .0218). Variables predictive of higher direct cost included a higher ASA status (<0.0001), higher Elixhauser Comorbidities Index (ECI) score (P = .004), and more segments involved in the procedure (P < .0001). Conversely, our models suggested that the 2 cohorts did not differ significantly in the odds of increased complications, readmission at 30 and 90 d, and ER visit at 30 or 90 d. CONCLUSION This study is the largest retrospective review, to our knowledge, of patients who have undergone PCDF with a specific focus on OSA. The results from this study suggest that OSA status is an important determinant of primary and secondary clinical outcomes following posterior cervical fusion procedures.

scholarly journals The Extracellular Matrix of the Lateral Pharyngeal Wall in Obstructive Sleep Apnea

SLEEP ◽  
2012 ◽  
Vol 35 (4) ◽  
pp. 483-490 ◽  
Author(s):  
Danielle Andrade da Silva Dantas ◽  
Thais Mauad ◽  
Luiz F. F. Silva ◽  
Geraldo Lorenzi-Filho ◽  
Gilberto G. S. Formigoni ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lateral Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Obstructive Sleep

scholarly journals A new rodent model for obstructive sleep apnea: effects on ATP-mediated dilations in cerebral arteries

2013 ◽  
Vol 305 (4) ◽  
pp. R334-R342 ◽  
Author(s):  
Randy F. Crossland ◽  
David J. Durgan ◽  
Eric E. Lloyd ◽  
Sharon C. Phillips ◽  
Anilkumar K. Reddy ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Rat Model ◽  
Cerebral Arteries ◽  
Upper Airway ◽  
Sleep Cycle ◽  
Control Group ◽  
Obstructive Sleep ◽  
Middle Cerebral Arteries ◽  
Sham Control Group

Obstructive sleep apnea (OSA), a condition in which the upper airway collapses during sleep, is strongly associated with metabolic and cardiovascular diseases. Little is known how OSA affects the cerebral circulation. The goals of this study were 1) to develop a rat model of chronic OSA that involved apnea and 2) to test the hypothesis that 4 wk of apneas during the sleep cycle alters endothelium-mediated dilations in middle cerebral arteries (MCAs). An obstruction device, which was chronically implanted into the trachea of rats, inflated to obstruct the airway 30 times/h for 8 h during the sleep cycle. After 4 wk of apneas, MCAs were isolated, pressurized, and exposed to luminally applied ATP, an endothelial P2Y2 receptor agonist that dilates through endothelial-derived nitric oxide (NO) and endothelial-dependent hyperpolarization (EDH). Dilations to ATP were attenuated ∼30% in MCAs from rats undergoing apneas compared with those from a sham control group ( P < 0.04 group effect; n = 7 and 10, respectively). When the NO component of the dilation was blocked to isolate the EDH component, the response to ATP in MCAs from the sham and apnea groups was similar. This finding suggests that the attenuated dilation to ATP must occur through reduced NO. In summary, we have successfully developed a novel rat model for chronic OSA that incorporates apnea during the sleep cycle. Using this model, we demonstrate that endothelial dysfunction occurred by 4 wk of apnea, likely increasing the vulnerability of the brain to cerebrovascular related accidents.

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