Dynamic upper airway narrowing in patients with obstructive sleep apnea

1986 ◽  
Vol 147 (6) ◽  
pp. 1330-1331
Author(s):  
I Rubinstein ◽  
N Zamel ◽  
V Hoffstein
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Airway Narrowing ◽  
Obstructive Sleep

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 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.

Variable site of airway narrowing among obstructive sleep apnea patients

1986 ◽  
Vol 61 (4) ◽  
pp. 1403-1409 ◽  
Author(s):  
D. W. Hudgel
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Balloon Catheter ◽  
Peak Inspiratory Pressure ◽  
Upper Airway ◽  
Repeated Measurements ◽  
Pressure Gradients ◽  
Airway Narrowing ◽  
Variable Site ◽  
Obstructive Sleep

The purpose of this was to determine whether the site of physiological narrowing within the upper airway was uniform or differed among patients with obstructive sleep apnea. Inspiratory pressures were measured with an esophageal balloon catheter and three catheters located at different sites along the upper airway: supralaryngeal airway, oropharynx, and nasopharynx. Peak inspiratory pressure differences between catheters allowed assessment of pressure gradients across three airway segments: lungs-larynx-retroepiglottal airway (esophageal-supralaryngeal pressure), hypopharynx (supralaryngeal-oropharynx pressure), and transpalatal airway (oropharynx-nasopharynx pressure). In five patients, hypopharyngeal obstruction was present, and in four patients no hypopharyngeal obstruction existed. In these four patients the site of obstruction was located at the level of the palate. In a given subject, the site of obstruction was the same during repeated measurements. The presence or absence of hypopharyngeal narrowing during sleep was not predictable from gradients measured across different segments of the upper airway during wakefulness. We conclude that the site of physiological upper airway obstruction varies among patients with obstructive sleep apnea and is not predictable from pressure measured during wakefulness. We speculate that uvulopalatopharyngoplasty may not relieve obstructive apneas in patients with hypopharyngeal obstruction.

scholarly journals Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Ara Darakjian ◽  
Ani B. Darakjian ◽  
Edward T. Chang ◽  
Macario Camacho
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Adequate Treatment ◽  
Airway Narrowing ◽  
Obstructive Sleep ◽  
Hyoid Suspension ◽  
Progression Of Disease

Diffuse Idiopathic Skeletal Hyperostosis (DISH) can cause ossification of ligaments and may affect the spine. We report a case of obstructive sleep apnea in a patient with significant upper airway narrowing secondary to cervical DISH. This patient had an initial apnea-hypopnea index (AHI) of 145 events/hour and was treated with uvulopalatopharyngoplasty, genial tubercle advancement, hyoid suspension, septoplasty, inferior turbinoplasties, and radiofrequency ablations to the tongue base which reduced his AHI to 40 events/hour. He redeveloped symptoms, was started on positive airway pressure (PAP) therapy, and later underwent a maxillomandibular advancement which improved his AHI to 16.3 events/hour. A few years later his AHI was 100.4 events/hour. His disease has gradually progressed over time and he was restarted on PAP therapy. Despite PAP titration, years of using PAP therapy, and being 100 percent compliant for the past three months (average daily use of 7.6 hours/night), he has an AHI of 5.1 events/hour and has persistent hypersomnia with an Epworth Sleep Scale questionnaire score of 18/24. At this time he is pending further hypersomnia work-up. DISH patients require prolonged follow-up to monitor the progression of disease, and they may require unconventional measures for adequate treatment of obstructive sleep apnea.

scholarly journals 1267 Severe Obstructive Sleep Apnea in Patient with Large Multinodular Goiter

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A482-A482
Author(s):  
Maria Macias ◽  
Ritwick Agrawal
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Supplemental Oxygen ◽  
Apnea Hypopnea Index ◽  
Thyroid Lobe ◽  
Airway Narrowing ◽  
Superior Mediastinum ◽  
Obstructive Sleep ◽  
Titration Study

Abstract Introduction Obstructive sleep apnea (OSA) is characterized by upper airway narrowing or closure during sleep. Age and obesity are common contributors, but large thyroid goiters have also been shown to contribute to OSA. Report of Case We report a case of a 65 year-old-man (BMI 47 kg/m2) who presents with dyspnea and intolerance to PAP therapy. He had a slowly progressive goiter which was first noticed at age 45. He declined thyroidectomy due to concern of complications. A recent CT reported markedly enlarged thyroid (right thyroid lobe 10.9 x 8.5 cm, left thyroid lobe 7.0 x 6.5 cm and thyroid isthmus 4.0 cm). It had extension into the superior mediastinum and circumferential encasement of the subglottic trachea with effacement involving the lateral walls. In past, he was non-tolerant with BPAP therapy due to high pressure settings (24/14 cm water). Multiple attempts to desensitize were not successful. Most recent diagnostic polysomnography reported an apnea hypopnea index (AHI) of 35.2/ hour, oxygen nadir of 77%. Supplemental oxygen was titrated upward to 5 LPM due to persistent oxygen desaturations in the absence of obstructive events. In the PAP titration study, despite multiple efforts and patient’s poor tolerance, the titration study was suboptimal. He was titrated to BPAP 15/11 and still had a residual AHI of 28.4/hour. Considering these findings thyroidectomy was again discussed which could potentially reduce OSA severity significantly. After long discussion, unfortunately the patient declined this recommendation. Other surgical options such as hypoglossal nerve stimulation was not technically feasible due to large goiter. Ultimately, he decided to remain on nightly supplemental oxygen. Conclusion Large multinodular goiters with retropharyngeal extension can worsen obstructive sleep apnea and pose unique diagnostic and therapeutic challenges. In this case, thyroidectomy may have led to improvement of degree of sleep disordered breathing.

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Lifeng Li ◽  
Demin Han ◽  
Hongrui Zang ◽  
Nyall R. London
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Subjective Sleep Quality ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

<b><i>Objective:</i></b> The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. <b><i>Methods:</i></b> Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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