scholarly journals The Usefulness of Modified Mallampati Score and CT Upper Airway Volume Measurements in Diagnosing OSA among Patients with Breathing-Related Sleep Disorders

2021 ◽  
Vol 11 (9) ◽  
pp. 3764
Author(s):  
Bartosz Dalewski ◽  
Agata Kamińska ◽  
Aleksandra Syrico ◽  
Alicja Kałdunska ◽  
Łukasz Pałka ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Upper Airway ◽  
Secondary Hypertension ◽  
Cone Beam ◽  
Berlin Questionnaire ◽  
Study Group ◽  
Upper Airways ◽  
Mallampati Score ◽  
Obstructive Sleep ◽  
Volume Measurements

Background: Obstructive sleep apnea (OSA) is a condition causing restriction of the airflow through the upper airways during sleep, despite preserved inspiratory muscle activity. This may lead to the development of secondary hypertension, ischemic heart disease, myocardial infarction, and arrhythmia. Moreover, the prevalence of OSA is on the rise. Methods: Comparison of scores from the Berlin Questionnaire, modified Mallampati scores (MMP), pulse oximetry readings and Upper Airway Volume (UAV) data obtained from CBCT (Cone Beam Computed Tomography). The study group of 129 patients of both sexes reporting sleep-related breathing problems completed the Berlin Questionnaire, had their oxygen saturation (SpO2) measured with a PO40 pulse oximeter, and oropharyngeal tissues assessed according to MMP. CBCT scans were put into 3D Amira TM 3D computer analysisto obtain UAV values. Results: Snoring was associated with significantly higher BMI compared to non-snoring patients. Furthermore, snoring patients had higher heart rate, modified Mallampati score, and lower UAV than the non-snoring group. The multifactorial analysis showed MMP as a useful indicator of the risk of snoring (OR = 7.468 (3863–14, 507, p < 0.001)). Conclusions: The composition of MMP together with UAV and the Berlin questionnaire might be reliable indicators to assess the risk of snoring.

Uvula Dynamic Characteristics

2013 ◽  
Author(s):  
A. M. Al-Jumaily ◽  
S. Ashaat ◽  
B. A. Martin ◽  
R. Heinzer ◽  
J. Haba Rubio ◽  
...  
Keyword(s):  
Dynamic Characteristics ◽  
Structural Model ◽  
Fluid Layer ◽  
Structural Characteristics ◽  
Upper Airway ◽  
Mode Shapes ◽  
Tissue Elasticity ◽  
Upper Airways ◽  
Obstructive Sleep ◽  
Mri Scans

The airway binary fluid layer and the structural characteristics of the upper airways have significant influence on the activity of the airway muscles by changing airway compliance and collapsibility during obstructive sleep apnea trauma. The uvula plays an important role in the collapse process. Using MRI scans, this paper develops a structural model for the uvula and determines its dynamic characteristics in terms of natural frequencies and mode shapes as a preliminary process to determine optimum conditions to therapeutically relieve upper airway obstruction. The effect of the variation of tissue elasticity due to water content is elaborated on.

scholarly journals Measurement of pharyngeal segments in Obstructive Sleep Apnea

2018 ◽  
Vol 21 (1) ◽  
pp. 64
Author(s):  
Marcos Marques Rodrigues ◽  
Lucas Borin Moura ◽  
Ariane De Souza Oliveira ◽  
Marisa Aparecida Cabrini Gabrielli ◽  
Valfrido Antonio Pereira Filho ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cone Beam Ct ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Cone Beam ◽  
Obstructive Sleep ◽  
Intimate Relation ◽  
The Mean ◽  
Cephalometric Measurements

<p><strong>Objective</strong>: Obstructive Sleep Apnea (OSA) occurs by recurrent collapse of the upper airway during sleep. It results in complete (apnea) or partial (hypopnea) reduction of airflow and has intimate relation with the upper airway anatomy. Cephalometric analysis has been used to quantify airway dimensions. The aim of this study is evaluate the correlation between the anteroposterior dimension of the upper airway and the severity of obstructive sleep apnea. <strong>Material and Methods</strong>: A retrospective analysis was performed reviewing polysomnographic data (AHI) and anteroposterior cephalometric measurements of pharynx subregions: nasopharynx, oropharynx, hypopharynx. <strong>Results</strong>: The sample consisted of 30 patients. The mean body mass index was 29.60 kg/m<sup>2</sup> and the average age was 46.8 years. Nine patients presented severe OSA, seven had moderate OSA , seven had mild OSA, and seven were healthy.  The Pearson's correlation index between the anteroposterior dimension of the nasopharynx, oropharynx and hypopharynx and AHI was respectively -0.128 (p=0.517), -0.272 (p=0.162) and -0.129 (p=0.513).<strong> Conclusion: </strong>The correlation between anteroposterior linear dimension of the airway and OSA severity, assessed by AHI, was not positive. As an isolated parameter it did not correlate to the severity of the obstrucive sleep apnea syndrome and should be evaluated in conjunction with other factors.</p><p><strong> </strong></p><p><strong>Keywords</strong></p><p>Upper Airway; Obstructive sleep apnea; Cone beam CT.</p>

scholarly journals Upper airway muscle activity in normal women: influence of hormonal status

1998 ◽  
Vol 84 (3) ◽  
pp. 1055-1062 ◽  
Author(s):  
Rainer M. Popovic ◽  
David P. White
Keyword(s):  
Postmenopausal Women ◽  
Muscle Activity ◽  
Airway Resistance ◽  
Upper Airway ◽  
Resistive Load ◽  
Substantial Impact ◽  
Upper Airway Resistance ◽  
Female Hormones ◽  
Dilator Muscle ◽  
Obstructive Sleep

Obstructive sleep apnea is a disorder with a strong male predominance. One possible explanation could be an effect of female hormones on pharyngeal dilator muscle activity. Therefore, we determined the level of awake genioglossus electromyogram (EMGgg) and upper airway resistance in 12 pre- and 12 postmenopausal women under basal conditions and during the application of an inspiratory resistive load (25 cmH2O ⋅ l−1 ⋅ s). In addition, a subgroup of eight postmenopausal women were studied a second time after 2 wk of combined estrogen and progesterone replacement in standard doses. Peak phasic and tonic genioglossus activity, expressed as a percentage of maximum, were highest in the luteal phase of the menstrual cycle (phasic 23.9 ± 3.8%, tonic 10.2 ± 1.0%), followed by the follicular phase (phasic 15.5 ± 2.2%, tonic 7.3 ± 0.8%), and were lowest in the postmenopausal group (phasic 11.3 ± 1.6%, tonic of 5.0 ± 0.6), whereas upper airway resistance did not differ. There was a weak but significant positive correlation between progesterone levels and both peak phasic ( P < 0.05) and tonic ( P < 0.01) EMGgg. Finally, there was a significant increase in EMGgg in the postmenopausal group restudied after hormone therapy. In conclusion, female hormones (possibly progesterone) have a substantial impact on upper airway dilator muscle activity.

scholarly journals OSA Upper Airways Surgery: A Targeted Approach

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 690
Author(s):  
Andrea De Vito ◽  
B. Tucker Woodson ◽  
Venkata Koka ◽  
Giovanni Cammaroto ◽  
Giannicola Iannella ◽  
...  
Keyword(s):  
Treatment Options ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Upper Airways ◽  
Drug Induced ◽  
Pharyngeal Wall ◽  
Obstructive Sleep ◽  
Number Of Patients ◽  
Methodological Bias

Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.

scholarly journals Computational fluid dynamics simulation of changes in the morphology and airflow dynamics of the upper airways in OSAHS patients after treatment with oral appliances

2019 ◽  
Author(s):  
Song Baolong ◽  
Li Yibo ◽  
Sun Jianwei ◽  
Qi Yizhe ◽  
Li Peng ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Upper Airway ◽  
Biomechanical Properties ◽  
Dynamics Simulation ◽  
Ct Scans ◽  
Oral Appliances ◽  
Upper Airways ◽  
Obstructive Sleep ◽  
Airway Morphology

AbstractObjectivesTo explore the changes of morphology and internal airflow in upper airways (UA) after the use of oral appliances (OAs) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and investigate the mechanisms by which OAs function as a therapy for OSAHS.MethodsEight OSAHS patients (all male, aged 37-58, mean age 46.25) underwent CT scans before and after OA use. Then, computational fluid dynamics(CFD) models were built on the base of the CT scans using Mimics and ANSYS ICEM CFD software. The internal airflow of the upper airways was simulated using ANSYS-FLUENT and the results were analyzed using ANSYS-CFD-Post. The data were analyzed to identify the most important changes of biomechanical properties between patients with and without OA intervention. Upper airway morphology and the internal airflow changes were compared using t-tests and Spearman correlation coefficient analysis.ResultsThe narrowest area of upper airways was found to be located in the lower bound of velopharynx, where the volume and pressure were statistically significantly increased (P<0.05) and the air velocity was statistically significantly decreased (P<0.05) in the presence of the OA(P<0.05). After wearing OA, pharyngeal resistance was significantly decreased (P<0.05), from 290.63 to 186.25Pa/L, and the airflow resistance of the pharynx has reduced by 35.9%.ConclusionThe enlargement of the upper airway after wearing the OA changed its airflow dynamics, which decreased the negative pressure and resistance in narrow areas of the upper airways. Thus, the collapsibility of the upper airways was reduced and patency was sustained.

Reduced genioglossal activity with upper airway anesthesia in awake patients with OSA

2000 ◽  
Vol 88 (4) ◽  
pp. 1346-1354 ◽  
Author(s):  
Robert B. Fogel ◽  
Atul Malhotra ◽  
Steven A. Shea ◽  
Jill K. Edwards ◽  
David P. White
Keyword(s):  
Muscle Activity ◽  
Upper Airway ◽  
Significant Rise ◽  
Tidal Breathing ◽  
Airflow Resistance ◽  
Dilator Muscle ◽  
Obstructive Sleep ◽  
Airway Mechanics ◽  
Airway Collapsibility ◽  
Negative Airway Pressure

We examined whether topical upper airway anesthesia leads to a reduction in genioglossal (GG) electromyogram (EMG) in patients with obstructive sleep apnea (OSA). Airway mechanics were also evaluated. In 13 patients with OSA, we monitored GG EMG during tidal breathing and during the application of pulses of negative airway pressure (−10 to −12 cmH2O). Airflow resistance and airway collapsibility were determined. All measurements were performed with and without topical anesthesia (lidocaine). Anesthesia led to a significant fall in the peak GG EMG response to negative pressure from 36.1 ± 4.7 to 24.8 ± 5.3% (SE) of maximum ( P < 0.01). This was associated with a fall in phasic and tonic EMG during tidal breathing (phasic from 24.4 ± 4.1 to 16.4 ± 3.4% of maximum and tonic from 10.9 ± 1.6 to 8.0 ± 1.3% of maximum, P < 0.01). A significant rise in pharyngeal airflow resistance was also observed. Our results demonstrate that topical receptor mechanisms in the nasopharynx importantly influence dilator muscle activity and are likely important in driving the augmented dilator muscle activity seen in the apnea patient.

scholarly journals The Relationship between Simple Snoring and Sleep Bruxism: A Polysomnographic Study

2020 ◽  
Vol 17 (23) ◽  
pp. 8960
Author(s):  
Monika Michalek-Zrabkowska ◽  
Mieszko Wieckiewicz ◽  
Piotr Macek ◽  
Pawel Gac ◽  
Joanna Smardz ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Body Position ◽  
Sleep Bruxism ◽  
The Body ◽  
Study Group ◽  
Upper Aerodigestive Tract ◽  
Obstructive Sleep ◽  
Supine Sleep ◽  
The Relationship ◽  
Simple Snoring

Simple snoring is defined as the production of sound in the upper aerodigestive tract during sleep, not accompanied by other pathologies. Sleep bruxism (SB) refers to repetitive phasic, tonic, or mixed masticatory muscle activity during sleep. In this study, we investigated the relationship between simple snoring and SB in patients without obstructive sleep apnea (OSA). A total of 565 snoring subjects underwent polysomnography. After examination, individuals with OSA were excluded from the study group. Finally, 129 individuals were analyzed. The bruxism episode index was positively correlated with maximum snore intensity. Phasic bruxism was positively correlated with snore intensity in all sleep positions. Bruxers had a significantly decreased average and minimum heart rate compared with non-bruxers. Supine sleep position seemed to have a significant impact on snore intensity and SB. In summary, our study showed the relationship between SB, snore intensity, and body position. Phasic bruxism was positively correlated with snore intensity despite the body position, which is an interesting and novel finding.

scholarly journals Oxygen desaturation during flexible bronchoscopy with propofol sedation is associated with sleep apnea: the PROSA-Study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrei M. Darie ◽  
Desiree M. Schumann ◽  
Marco Laures ◽  
Werner Strobel ◽  
Kathleen Jahn ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Conscious Sedation ◽  
Flexible Bronchoscopy ◽  
Oxygen Desaturation ◽  
Clinical Indication ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Upper Airways ◽  
Peripheral Oxygen Saturation ◽  
Obstructive Sleep

Abstract Background Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial obstruction of the upper airways during sleep. Conscious sedation for flexible bronchoscopy (FB) places patients in a sleep-like condition. We hypothesize that oxygen desaturation during flexible bronchoscopy may help to detect undiagnosed sleep apnea. Methods Single-centre, investigator-initiated and driven study including consecutive patients undergoing FB for clinical indication. Patients completed the Epworth Sleepiness Scale (ESS), Lausanne NoSAS score, STOP-BANG questionnaire and the Berlin questionnaire and underwent polygraphy within 7 days of FB. FB was performed under conscious sedation with propofol. Oxygen desaturation during bronchoscopy was measured with continuous monitoring of peripheral oxygen saturation with ixTrend (ixellence GmbH, Germany). Results 145 patients were included in the study, 62% were male, and the average age was 65.8 ± 1.1 years. The vast majority of patients (n = 131, 90%) proved to fulfill OSA criteria based on polygraphy results: 52/131 patients (40%) had mild sleep apnea, 49/131 patients (37%) moderate sleep apnea and 30/131 patients (23%) severe sleep apnea. Patients with no oxygen desaturation had a significantly lower apnea–hypopnea index than patients with oxygen desaturation during bronchoscopy (AHI 11.94/h vs 21.02/h, p = 0.011). This association remained significant when adjusting for the duration of bronchoscopy and propofol dose (p = 0.023; 95% CI 1.382; 18.243) but did not hold when also adjusting for age and BMI. Conclusion The severity of sleep apnea was associated to oxygen desaturation during flexible bronchoscopy under conscious sedation. Patients with oxygen desaturation during bronchoscopy might be considered for sleep apnea screening. Trial registration: The Study was approved by the Ethics Committee northwest/central Switzerland, EKNZ (EK 16/13) and was carried out according to the Declaration of Helsinki and Good Clinical Practice guidelines. Due to its observational character, the study did not require registration at a clinical trial registry.

scholarly journals Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature

2019 ◽  
Vol 8 (11) ◽  
pp. 1846 ◽  
Author(s):  
Taranto-Montemurro ◽  
Messineo ◽  
Wellman
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Muscle Activity ◽  
Upper Airway ◽  
Loop Gain ◽  
Arousal Threshold ◽  
The Past ◽  
Obstructive Sleep ◽  
Near Future ◽  
Made In

Obstructive sleep apnea (OSA) is a highly prevalent condition with few therapeutic options. To date there is no approved pharmacotherapy for this disorder, but several attempts have been made in the past and are currently ongoing to find one. The recent identification of multiple endotypes underlying this disorder has oriented the pharmacological research towards tailored therapies targeting specific pathophysiological traits that contribute differently to cause OSA in each patient. In this review we retrospectively analyze the literature on OSA pharmacotherapy dividing the medications tested on the basis of the four main endotypes: anatomy, upper airway muscle activity, arousal threshold and ventilatory instability (loop gain). We show how recently introduced drugs for weight loss that modify upper airway anatomy may play an important role in the management of OSA in the near future, and promising results have been obtained with drugs that increase upper airway muscle activity during sleep and reduce loop gain. The lack of a medication that can effectively increase the arousal threshold makes this strategy less encouraging, although recent studies have shown that the use of certain sedatives do not worsen OSA severity and could actually improve patients’ sleep quality.

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