scholarly journals A retrospective study: does upper airway morphology differ between non-positional and positional obstructive sleep apnea?

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3918 ◽  
Author(s):  
Xiao Jiao ◽  
Jianyin Zou ◽  
Suru Liu ◽  
Jian Guan ◽  
Hongliang Yi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Retrospective Study ◽  
Sleep Apnea ◽  
Soft Palate ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Airway Morphology

Objective The objective of this study was to explore the differences in upper airway morphology between positional (POSA) and non-positional (NPOSA) obstructive sleep apnea. Methods This retrospective study enrolled 75 patients (45 NPOSA and 30 POSA) who underwent polysomnography (PSG) and computed tomography (CT). The differences in, and relationships of, the PSG values and CT data between POSA and NPOSA were analyzed. Results Significant (p < 0.05) differences between the two groups were found in the apnea/hypopnea index (AHI), lateral-AHI (L-AHI), soft palate length (SPL), cross-sectional palatopharyngeal area, and the coronal diameter (CD) of the palatopharyngeal area at the narrowest part of the glossopharynx, which were all higher in POSA, except for SPL, AHI, and L-AHI. L-AHI was correlated with the cross-sectional area (r =  − 0.306, p = 0.008) and CD (r =  − 0.398, p < 0.001) of the palatopharyngeal area, the cross-sectional area (r =  − 0.241, p = 0.038) and CD (r =  − 0.297, p = 0.010) of the narrowest level of the glossopharynx, the CD of the glossopharynx (r = 0.284, p = 0.013), body mass index (BMI, r = 0.273, p = 0.018), SPL (r = 0.284, p = 0.014), and vallecula-tip of tongue (r = 0.250, p = 0.030). The SPL and CD at the narrowest part of the glossopharynx were included in the simplified screening model. Conclusions In NPOSA, the CD of the upper airway was smaller, and the soft palate was longer, than in POSA. These differences may play significant roles in explaining the main differences between NPOSA and POSA.

Retropalatal Cross-Sectional Area Is Predictive of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis

2019 ◽  
Vol 57 (5) ◽  
pp. 560-565 ◽  
Author(s):  
Cory M. Resnick ◽  
Jason K. Middleton ◽  
Carly E. Calabrese ◽  
Karan Ganjawalla ◽  
Bonnie L. Padwa
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Cross Sectional Area ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Sectional Area ◽  
Cross Sectional ◽  
Syndromic Craniosynostosis ◽  
Obstructive Sleep

Objective: There is a high rate of obstructive sleep apnea (OSA) in patients with syndromic craniosynostosis (SCS). Little is known about the airway anatomy in this population. The purpose of this study is to characterize the 3 dimensional (3D) upper airway in patients with SCS with and without OSA. Design: This is a retrospective study of patients with SCS treated at Boston Children’s Hospital from 2000 to 2015. Patients were divided into OSA and no-OSA groups based on polysomnography. Predictor variables included age, sex, body mass index (BMI), and 3D upper airway measurements. The primary outcome variable was the presence or absence of OSA. Secondary outcome variables were apnea–hypopnea index and oxygen saturation nadir. Descriptive and bivariate statistics were computed, and significance was set as P < .05. Results: There were 24 patients: 16 in the OSA group and 8 in the no-OSA group. The 2 groups did not differ significantly by age, BMI, or syndromic diagnosis. The presence of OSA was associated with a smaller minimum retropalatal cross-sectional area (minRPCSA; P < .001). In a logistic regression model controlling for age, sex, and upper airway length, minRPCSA was the primary predictor of OSA ( P ≤ .002). Receiver operating characteristic analysis determined minRPCSA = 55.3 mm2 to be the optimal diagnostic threshold for OSA, with sensitivity = 100% and specificity = 87.5% ( P < .001). Conclusion: A minRPCSA ≤55.3 mm2 is predictive of the presence of OSA in patients with SCS.

Interaction of cross-sectional area, driving pressure, and airflow of passive velopharynx

1997 ◽  
Vol 83 (3) ◽  
pp. 851-859 ◽  
Author(s):  
Shiroh Isono ◽  
Thom R. Feroah ◽  
Eric A. Hajduk ◽  
Rollin Brant ◽  
William A. Whitelaw ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Positive Airway Pressure ◽  
Cross Sectional Area ◽  
Driving Pressure ◽  
Sectional Area ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Pharyngeal Muscles ◽  
The Relationship

Isono, Shiroh, Thom R. Feroah, Eric A. Hajduk, Rollin Brant, William A. Whitelaw, and John E. Remmers. Interaction of cross-sectional area, driving pressure, and airflow of passive velopharynx. J. Appl. Physiol. 83(3): 851–859, 1997.—Previous studies have shown that, when the pharyngeal muscles are relaxed, the velopharynx is a highly compliant segment of the pharynx. Thus, under these circumstances, cross-sectional area of the velopharynx ( A VP), driving pressure across the velopharynx (ΔP), and inspiratory airflow (V˙i) will be mutually interdependent variables. The purpose of the present investigation was to describe the interrelation among these three variables during inspiration. We studied 15 sleeping patients with obstructive sleep apnea/hypopnea when the pharyngeal muscles were rendered hypotonic by applying continuous positive airway pressure to the nasal airway. A VP, determined by endoscopic imaging, was significantly greater at onset ofV˙i limitation than at minimum oropharyngeal pressure ( P < 0.01). Snoring was never observed duringV˙ilimitation. In a subgroup of six patients, values for ΔP,V˙i, and A VP were obtained at 0.1-s intervals at various levels of mask pressure. For these six patients, the mathematical expressionV˙i = 0.657( A VP/ A max) ⋅ ΔP0.332, where A max is maximal A VP, described the relationship among the three variables ( R 2 = 0.962) for flow-limited and non-flow-limited inspirations. The impedance of the passive velopharynx, defined as ΔP0.33/V˙, was inversely related to A VP and increased dramatically when A VP was <0.3 cm2. In summary, we observed a progressive decrease in A VP during flow-limited inspiration in patients with obstructive sleep apnea. This constriction of the velopharynx contributes to an increase in velopharyngeal impedance that, in turn, counterbalances the increase in ΔP during flow limitation.

Ansa Cervicalis Stimulation Increases Pharyngeal Patency in Patients with Obstructive Sleep Apnea

2021 ◽  
Author(s):  
David T. Kent ◽  
William C. Scott ◽  
David Zealear ◽  
Alan R. Schwartz
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Hypoglossal Nerve ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Ansa Cervicalis ◽  
Obstructive Sleep ◽  
The Right ◽  
Stimulation Of

Rationale: Hypoglossal nerve stimulation (HNS) is an alternative treatment option for obstructive sleep apnea (OSA) that reduces pharyngeal collapsibility, but HNS non-responders often demonstrate continued retropalatal and lateral pharyngeal wall collapse. Recent evidence suggests that caudal pharyngeal traction with sternothyroid muscle contraction via ansa cervicalis stimulation (ACS) can also stabilize the pharynx, but the underlying mechanisms have not been elucidated. Objectives: To evaluate the effect of ACS on pharyngeal patency during expiration when the airway is most hypotonic. Methods: Eight participants with OSA underwent sustained ultrasound-guided fine-wire stimulation of the medial branch of the right hypoglossal nerve with and without transient stimulation of the branch of the ansa cervicalis nerve plexus innervating the right sternothyroid muscle during drug-induced sleep endoscopy. Airway cross-sectional area and expiratory airflow (VE) were measured from endoscopy video with ImageJ and pneumotachometry, respectively. Measurements and Main Results: ACS significantly increased retropalatal cross-sectional area (CSArp) to 211% [159-263] of unstimulated CSArp (p<0.05). Adding ACS to HNS increased CSArp from baseline by 341% [244-439] (p<0.05), a 180% [133-227] increase over isolated HNS (p<0.05). ACS increased VE from baseline by 177% [138-217] (p < 0.05). Adding ACS to HNS increased VE by 254% [207-301], reflecting decreases in pharyngeal collapsibility. Conclusions: Combining ACS with HNS increased retropalatal cross-sectional area and increased expiratory airflow, suggesting decreases in pharyngeal collapsibility. Our findings suggest that ACS exerts caudal traction on the upper airway through sternothyroid muscle contraction, and that it may augment HNS efficacy in patients with OSA.

Upper airway morphological changes in obstructive sleep apnoea: effect of age on pharyngeal anatomy

2020 ◽  
Vol 134 (4) ◽  
pp. 354-361
Author(s):  
F Gao ◽  
Y R Li ◽  
W Xu ◽  
Y S An ◽  
H J Wang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Airway Morphology

AbstractObjectiveTo evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea.MethodsA total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed.ResultsSoft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2.ConclusionA number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.

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