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.

scholarly journals Upper Airway Collapsibility During REM Sleep in Children with the Obstructive Sleep Apnea Syndrome

SLEEP ◽  
2009 ◽  
Vol 32 (9) ◽  
pp. 1173-1181 ◽  
Author(s):  
Jingtao Huang ◽  
Laurie R. Karamessinis ◽  
Michelle E. Pepe ◽  
Stephen M. Glinka ◽  
John M. Samuel ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Rem Sleep ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Obstructive Sleep ◽  
Airway Collapsibility ◽  
Apnea Syndrome ◽  
Upper Airway Collapsibility

scholarly journals Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome

2019 ◽  
Vol 24 (01) ◽  
pp. e107-e111 ◽  
Author(s):  
José Antonio Pinto ◽  
Luciana Balester Mello de Godoy ◽  
Heloisa dos Santos Sobreira Nunes ◽  
Kelly Elia Abdo ◽  
Gabriella Spinola Jahic ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Surgical Techniques ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Lateral Expansion ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively (p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice.

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 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 Desipramine improves upper airway collapsibility and reduces OSA severity in patients with minimal muscle compensation

2016 ◽  
Vol 48 (5) ◽  
pp. 1340-1350 ◽  
Author(s):  
Luigi Taranto-Montemurro ◽  
Scott A. Sands ◽  
Bradley A. Edwards ◽  
Ali Azarbarzin ◽  
Melania Marques ◽  
...  
Keyword(s):  
Crossover Trial ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Double Blind ◽  
Healthy Humans ◽  
Dilator Muscle ◽  
Obstructive Sleep ◽  
Airway Collapsibility ◽  
Upper Airway Collapsibility

We recently demonstrated that desipramine reduces the sleep-related loss of upper airway dilator muscle activity and reduces pharyngeal collapsibility in healthy humans without obstructive sleep apnoea (OSA). The aim of the present physiological study was to determine the effects of desipramine on upper airway collapsibility and apnoea–hypopnea index (AHI) in OSA patients.A placebo-controlled, double-blind, randomised crossover trial in 14 OSA patients was performed. Participants received treatment or placebo in randomised order before sleep. Pharyngeal collapsibility (critical collapsing pressure of the upper airway (Pcrit)) and ventilation under both passive (V′0,passive) and active (V′0,active) upper airway muscle conditions were evaluated with continuous positive airway pressure (CPAP) manipulation. AHI was quantified off CPAP.Desipramine reduced activePcrit(median (interquartile range) −5.2 (4.3) cmH2O on desipramineversus−1.9 (2.7) cmH2O on placebo; p=0.049) but not passivePcrit(−2.2 (3.4)versus−0.7 (2.1) cmH2O; p=0.135). A greater reduction in AHI occurred in those with minimal muscle compensation (defined asV′0,active−V′0,passive) on placebo (r=0.71, p=0.009). The reduction in AHI was driven by the improvement in muscle compensation (r=0.72, p=0.009).In OSA patients, noradrenergic stimulation with desipramine improves pharyngeal collapsibility and may be an effective treatment in patients with minimal upper airway muscle compensation.

Mass loading of the upper airway extraluminal tissue space in rabbits: effects on tissue pressure and pharyngeal airway lumen geometry

2009 ◽  
Vol 106 (3) ◽  
pp. 887-892 ◽  
Author(s):  
Kristina Kairaitis ◽  
Lauren Howitt ◽  
John R. Wheatley ◽  
Terence C. Amis
Keyword(s):  
Pressure Transducer ◽  
Tissue Expander ◽  
Upper Airway ◽  
Fat Pad ◽  
Pharyngeal Wall ◽  
Airway Patency ◽  
Pharyngeal Airway ◽  
Obstructive Sleep ◽  
Tracheal Pressure ◽  
Tissue Space

Lateral pharyngeal fat pad compression of the upper airway (UA) wall is thought to influence UA size in patients with obstructive sleep apnea. We examined interactions between acute mass/volume loading of the UA extra-luminal tissue space and UA patency. We studied 12 supine, anesthetized, spontaneously breathing, head position-controlled (50°), New Zealand White rabbits. Submucosal extraluminal tissue pressures (ETP) in the anterolateral (ETPlat) and anterior (ETPant) pharyngeal wall were monitored with surgically inserted pressure transducer-tipped catheters (Millar). Tracheal pressure (Ptr) and airflow (V̇) were measured via a pneumotachograph and pressure transducer inserted in series into the intact trachea, with hypopharyngeal cross-sectional area (CSA) measured via computed tomography, while graded saline inflation (0–1.5ml) of a compliant tissue expander balloon in the anterolateral subcutaneous tissue was performed. Inspiratory UA resistance (Rua) at 20 ml/s was calculated from a power function fitted to Ptr vs. V̇ data. Graded expansion of the anterolateral balloon increased ETPlat from 2.3 ± 0.5 cmH2O ( n = 11, mean ± SEM) to 5.0 ± 1.1 cmH2O at 1.5-ml inflation ( P < 0.05; ANOVA). However, ETPant was unchanged from 0.5 ± 0.5 cmH2O ( n = 9; P = 0.17). Concurrently, Rua increased to 119 ± 4.2% of baseline value ( n = 12; P < 0.001) associated with a significant reduction in CSA between 10 and 70% of airway length to a minimum of 82.2 ± 4.4% of baseline CSA at 40% of airway length ( P < 0.05). We conclude that anterolateral loading of the upper airway extraluminal tissue space decreases upper airway patency via an increase in ETPlat, but not ETPant. Lateral pharyngeal fat pad size may influence UA patency via increased tissue volume and pressure causing UA wall compression.

scholarly journals Airway inflammation in patients affected by obstructive sleep apnea

2016 ◽  
Vol 65 (2) ◽  
Author(s):  
R. Sabato ◽  
P. Guido ◽  
F.G. Salerno ◽  
O. Resta ◽  
A. Spanevello ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Inflammation ◽  
Systemic Inflammation ◽  
Inflammatory Mediators ◽  
Upper Airway ◽  
Airway Hyperreactivity ◽  
Variable Degree ◽  
Airway Occlusion ◽  
Obstructive Sleep

Obstructive sleep apnea (OSA) is characterised by repetitive episodes of upper airway occlusion during sleep. OSA has been shown to be associated with a variable degree of nasal inflammation, uvula mucosal congestion and airway hyperreactivity. The upper airway inflammation, whose clinical importance is uncertain, is characterised by leukocytes infiltration and interstitial oedema. In addition, recent data has shown the presence of neutrophilic inflammation in the lower airways. The current opinion is that airway inflammation is caused by the local, repeated mechanical trauma related to the intermittent airway occlusion typical of the disease. Another potential mechanism involves the intermittent nocturnal hypoxemia that through the phenomenon of the ischemia- reperfusion injury may induce the production of oxygen free radicals and therefore cause local and systemic inflammation. Finally, a state of low-grade systemic inflammation may be related to obesity per se with the pro-inflammatory mediators synthesised in the visceral adipose cells. Several authors stress the role of circulating and local inflammatory mediators, such as proinflammatory cytokines, exhaled nitric oxide, pentane and 8-isoprostane as the determinants of inflammation in OSA.

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>

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