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Thuler ER, Parekh MH, Rodin JG, Seay EG, Wiemken A, Keenan BT, Schwab RJ, Schwartz AR, Dedhia RC. Association Between Soft Tissue Measures From Computed Tomography and Upper Airway Collapsibility on Drug-Induced Sleep Endoscopy. Otolaryngol Head Neck Surg 2024; 171:578-587. [PMID: 38613204 DOI: 10.1002/ohn.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Positive airway pressure (PAP) titration during drug-induced sleep endoscopy (DISE) provides objective measures of upper airway collapsibility. While skeletal measurements relate to collapsibility measures on DISE, the influence of soft tissue dimensions on upper airway collapsibility is not known. We analyzed the relationship of measures of upper airway soft tissue volumes, specifically soft palate, pharyngeal lateral walls, and tongue, with metrics of collapsibility. STUDY DESIGN Cross-sectional analysis from a prospective cohort. SETTING Academic medical center. METHODS Patients seeking PAP alternative therapies for obstructive sleep apnea (OSA) underwent standardized supine computed tomography (CT) acquisition and DISE protocols. The CT analysis primarily focused on soft tissue volumes and, secondarily, on airway and skeletal volumetric measures. DISE with PAP administration (DISE-PAP) enabled the determination of the pressure at which inspiratory airflow first commenced (pharyngeal critical pressure, PcritA) and the pressure at which inspiratory flow limitation was abolished (pharyngeal opening pressure, PhOP). Both unadjusted and adjusted correlation analyses were performed to understand the relationship between upper airway anatomy and either PcritA or PhOP. RESULTS One hundred thirty-nine subjects completed both CT and DISE-PAP. On average, patients were male (70.5%), white (84.2%), middle-aged (56.6 ± 13.5 years), and overweight (29.6 ± 4.7 kg/m2), with moderate-severe apnea-hypopnea index (29.7 ± 21.3 events/h). Adjusted for age, sex, body mass index, and skeletal volumes, soft palate, and lateral pharyngeal wall volumes were not associated with PhOP or PcritA, but a larger tongue was associated with more positive PhOP (⍴ = 0.20, P = .02), and more positive PcritA (⍴ = 0.16, P = .07). Exploratory analyses revealed smaller minimum cross-sectional retropalatal area and intramandibular volume were also associated with increased collapsibility measures. CONCLUSION After controlling for clinical factors and skeletal volume, greater tongue volume was associated with more severe collapsibility during DISE. These results, in concert with previous work, suggest that greater tongue volume in a smaller skeletal dimensions contribute to the severity of airway collapsibility, a key driver of OSA pathogenesis.
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Affiliation(s)
- Eric R Thuler
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Manan H Parekh
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jules G Rodin
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Everett G Seay
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Wiemken
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brendan T Keenan
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Richard J Schwab
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alan R Schwartz
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of Sleep Medicine, Universidad Peruana Cayetano Heredia School of Medicine, Lima, Peru
| | - Raj C Dedhia
- Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Schwab RJ, Lin TC, Wiemken A, Dedhia RC, Wehrli FW, Keenan BT. State-Dependent Biomechanical Behavior of Oropharyngeal Structures in Apneic and Control Subjects: A Proof-of-Concept Study. Ann Am Thorac Soc 2024; 21:949-960. [PMID: 38507612 PMCID: PMC11160136 DOI: 10.1513/annalsats.202309-847oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/20/2024] [Indexed: 03/22/2024] Open
Abstract
Rationale: Apneic individuals have reduced airway caliber during sleep. The biomechanical changes in upper airway anatomy contributing to this airway narrowing are largely unknown. Objectives: We sought to investigate the state-dependent (wake vs. sleep) biomechanical behavior of the upper airway soft-tissue and craniofacial structures. Methods: Upper airway magnetic resonance imaging was performed in 15 sleep-deprived control subjects (apnea-hypopnea index, <5; 0.3 ± 0.5 events per hour) and 12 sleep-deprived apneic subjects (apnea-hypopnea index, ⩾5; 35.2 ± 18.1 events per hour) during wake and sleep and analyzed for airway measures and soft-tissue/mandibular movement. Results: In the retropalatal region, control subjects showed sleep-dependent reductions (P ⩽ 0.037) in average cross-sectional airway area (CSA), minimum CSA, and anteroposterior and lateral dimensions. Apneic subjects showed sleep-dependent reductions (P ⩽ 0.002) in average CSA, minimum CSA, and anteroposterior and lateral dimensions. In the retroglossal region, control subjects had no sleep-dependent airway reductions. However, apneic subjects had sleep-dependent reductions in minimal CSA (P = 0.001) and lateral dimensions (P = 0.014). Control subjects only showed sleep-dependent posterior movement of the anterior-inferior tongue octant (P = 0.039), whereas apneic subjects showed posterior movement of the soft palate (P = 0.006) and all tongue octants (P ⩽ 0.012). Sleep-dependent medial movement of the lateral walls was seen at the retropalatal minimum level (P = 0.013) in control subjects and at the retropalatal and retroglossal minimum levels (P ⩽ 0.017) in apneic subjects. There was posterior movement of the mandible in apneic subjects (P ⩽ 0.017). Conclusions: During sleep, control and apneic subjects showed reductions in retropalatal airway caliber, but only the apneic subjects showed retroglossal airway narrowing. Reductions in anteroposterior and lateral airway dimensions were primarily due to posterior soft palate, tongue and mandibular movement and to medial lateral wall movement. These data provide important initial insights into obstructive sleep apnea pathogenesis.
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Affiliation(s)
| | - Theodore C. Lin
- Division of Sleep Medicine, Department of Medicine
- Department of Otorhinolaryngology – Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania
| | | | - Raj C. Dedhia
- Division of Sleep Medicine, Department of Medicine
- Department of Otorhinolaryngology – Head and Neck Surgery, and
| | - Felix W. Wehrli
- Laboratory for Structural, Physiologic, and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Ulualp SO, Kezirian EJ. Advanced Diagnostic Techniques in Obstructive Sleep Apnea. Otolaryngol Clin North Am 2024; 57:371-383. [PMID: 38485538 DOI: 10.1016/j.otc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
Optimal surgical and medical management of obstructive sleep apnea requires clinically reliable identification of patterns and sites of upper airway obstruction. A wide variety of modalities have been used to evaluate upper airway obstruction. Drug-induced sleep endoscopy (DISE) and cine MRI are increasingly used to identify upper airway obstruction sites, to characterize airway obstruction patterns, to determine optimum medical and surgical treatment, and to plan individualized surgical management. Here, we provide an overview of the applications of DISE and cine MRI in assessing upper airway obstruction in children and adults with obstructive sleep apnea.
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Affiliation(s)
- Seckin O Ulualp
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Division of Pediatric Otolaryngology, Children's Health, 2360 North Stemmons Freeway, F6.215, Dallas, TX 75207, USA.
| | - Eric J Kezirian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Head and Neck Surgery, 1131 Wilshire Boulevard, Suite 302, Santa Monica, CA 90401, USA
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Ulualp SO, Kezirian EJ. Advanced Diagnostic Techniques in Obstructive Sleep Apnea. Otolaryngol Clin North Am 2024:S0030-6665(24)00033-1. [PMID: 38519293 DOI: 10.1016/j.otc.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Optimal surgical and medical management of obstructive sleep apnea (OSA) requires clinically reliable identification of patterns and sites of upper airway obstruction. A wide variety of modalities has been used to evaluate upper airway obstruction. Drug-induced sleep endoscopy (DISE) and cine MRI are increasingly used to identify upper airway obstruction sites, to characterize airway obstruction patterns, to determine optimum medical and surgical treatment, and to plan individualized surgical management. Here, the authors provide an overview of the applications of DISE and cine MRI in assessing upper airway obstruction in children and adults with OSA.
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Affiliation(s)
- Seckin O Ulualp
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Division of Pediatric Otolaryngology, Children's Health, 2360 North Stemmons Freeway, F6.215, Dallas, TX 75207, USA.
| | - Eric J Kezirian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Head and Neck Surgery, 1131 Wilshire Boulevard, Suite 302, Santa Monica, CA 90401, USA
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Li Y, Ji C, Sun W, Xiong H, Li Z, Huang X, Fan T, Xian J, Huang Y. Characteristics and Mechanism of Upper Airway Collapse Revealed by Dynamic MRI During Natural Sleep in Patients with Severe Obstructive Sleep Apnea. Nat Sci Sleep 2023; 15:885-902. [PMID: 37933249 PMCID: PMC10625767 DOI: 10.2147/nss.s423303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose Upper airway collapse during sleep in patients with obstructive sleep apnea (OSA) is a complex and dynamic phenomenon. By observing and analyzing the dynamic changes in the upper airway and its surrounding tissues during airway obstruction, we aim to reveal dynamic characteristics in different obstruction patterns, and the relationship between anatomical features during normal breathing and dynamic characteristics of airway obstruction. Patients and Methods Dynamic MRI was performed in 23 male patients (age range 26-63) with severe OSA diagnosed by overnight polysomnography, and obstruction events were identified from their images. Dynamic changes in parameters of the upper airway and surrounding tissues were measured to assess the key characteristics in different obstruction patterns. Results We categorized airway obstruction into four types based on the obstruction location and motion characteristics of tissues during collapse, and detailed the alterations in the airway and surrounding tissues under each obstruction pattern. In all 112 obstruction events extracted from the dynamic images of 23 patients, type A (retropalatal obstruction caused by the soft palate separated from the tongue), BI, BII (both retropalatal obstructions caused by the soft palate attached to the tongue, and C (retropalatal and retroglossal obstruction caused by the soft palate and the tongue), accounted for 28.6%, 44.6%, 12.5%, and 14.3% respectively. In severe OSA patients with tongue and palatal obstruction related to type B or C, the more posterior hyoid position, shorter distance between tongue and uvula, and wider retropalatal space, the larger the tongue displacement and deformation during collapse, and the greater the reduction in airway space. Conclusion There are multiple airway obstruction patterns, each with its own anatomical characteristics and behaviors during collapse. Hyoid position, tongue and uvula distance, and retropalatal space play an important role in airway collapse and should be paid more attention in the treatment of OSA.
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Affiliation(s)
- Yuqi Li
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Changjin Ji
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Weiao Sun
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Huahui Xiong
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiaoqing Huang
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Tingting Fan
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yaqi Huang
- School of Biomedical Engineering, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, People’s Republic of China
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Thuler E, Seay EG, Woo J, Lee J, Jafari N, Keenan BT, Dedhia RC, Schwartz AR. Transverse Maxillary Deficiency Predicts Increased Upper Airway Collapsibility during Drug-Induced Sleep Endoscopy. Otolaryngol Head Neck Surg 2023; 169:412-421. [PMID: 36939430 DOI: 10.1002/ohn.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To examine the relationship between craniofacial skeletal anatomy and objective measures of pharyngeal collapse obtained during drug-induced sleep endoscopy. We hypothesized that transverse maxillary deficiency and an increased pharyngeal length will be associated with higher levels of pharyngeal collapsibility. STUDY DESIGN Cross-sectional analysis in a prospective cohort. SETTING University Hospital. METHODS A cross-sectional analysis was conducted in a cohort of consecutive patients from the positive airway pressure (PAP) alternatives clinic who underwent computed tomography (CT) analysis and drug-induced sleep endoscopy for characterization of upper airway collapsibility. PAP titration was used to determine pharyngeal critical pressure (PCRIT ) and pharyngeal opening pressure (PhOP). CT metrics included: Transverse maxillary dimensions (interpremolar and intermolar distances) and pharyngeal length (posterior nasal spine to hyoid distance). RESULTS The cohort (n = 103) of severe obstructive sleep apnea (Apnea and Hipopnea Index 32.1 ± 21.3 events/h) was predominantly male (71.8%), Caucasian (81.6%), middle-aged (54.4 ± 14.3 years), and obese (body mass index [BMI] = 30.0 ± 4.9 kg/m2 ). Reduced transverse maxillary dimensions were associated with higher PCRIT (intermolar distance: β [95% confidence interval, CI] = -.25 [-0.14, -0.36] cmH2 O/mm; p = .03) and PhOP (Interpremolar distance: β = -.25 [-0.14, -0.36] cmH2 O/mm; p = .02). Longer pharyngeal length was also associated with higher PCRIT (β = .11 [0.08, 0.14] cmH2 O/mm, p = .04) and PhOP (β [95% CI] = .06 [0.03, 0.09] cmH2 O/mm, p = .04). These associations persisted after adjustments for sex, age, height, and BMI. CONCLUSION Our results further the concept that skeletal restriction in the transverse dimension and hyoid descent are associated with elevations in pharyngeal collapsibility during sleep, suggesting a role of transverse deficiency in the pathogenesis of airway obstruction.
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Affiliation(s)
- Eric Thuler
- Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Everett G Seay
- Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John Woo
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jane Lee
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Niusha Jafari
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Raj C Dedhia
- Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alan R Schwartz
- Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Otorhinolaryngology, Universidad Peruana Cayetano Heredia School of Medicine, Lima, Peru
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Volner K, Chao S, Camacho M. Dynamic sleep MRI in obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:595-607. [PMID: 34241671 PMCID: PMC8266991 DOI: 10.1007/s00405-021-06942-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/11/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE The objective of this study is to systematically review the international literature for dynamic sleep magnetic resonance imaging (MRI) as a diagnostic tool in obstructive sleep apnea (OSA), to perform meta-analysis on the quantitative data from the review, and to discuss its implications in future research and potential clinical applications. STUDY DESIGN A comprehensive review of the literature was performed, followed by a detailed analysis of the relevant data that has been published on the topic. METHODS Clinical key, Uptodate, Ovid, Ebscohost, Pubmed/MEDLINE, Scopus, Dynamed, Web of Science and The Cochrane Library were systematically searched. Once the search was completed, dynamic sleep MRI data were analyzed. RESULTS Nineteen articles reported on 410 OSA patients and 79 controls that underwent dynamic sleep MRI and were included in this review. For meta-analysis of dynamic sleep MRI data, eight articles presented relevant data on 160 OSA patients. Obstruction was reported as follows: retropalatal (RP) 98%, retroglossal (RG) 41% and hypopharyngeal (HP) in 5%. Lateral pharyngeal wall (LPW) collapse was found in 35/73 (48%) patients. The combinations of RP + RG were observed in 24% and RP + RG + LPW in 16%. If sedation was used, 98% of study participants fell asleep compared to 66% of unsedated participants. CONCLUSIONS Dynamic sleep MRI has demonstrated that nearly all patients have retropalatal obstruction, retroglossal obstruction is common and hypopharyngeal obstruction is rare. Nearly all patients (98%) who are sedated are able to fall asleep during the MRI. There is significant heterogeneity in the literature and standardization is needed.
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Affiliation(s)
- Keith Volner
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center Honolulu, Honolulu, USA, 1 Jarrett White Road, Hawaii, 96859.
| | - Silas Chao
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center Honolulu, Honolulu, USA, 1 Jarrett White Road, Hawaii, 96859
| | - Macario Camacho
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center Honolulu, Honolulu, USA, 1 Jarrett White Road, Hawaii, 96859
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Bindi I, Ori M, Marchegiani M, Morreale M, Gallucci L, Ricci G. Diagnosis of upper airways collapse in moderate-to-severe OSAHS patients: a comparison between drug-induced sleep endoscopy and the awake examination. Eur Arch Otorhinolaryngol 2021; 279:2167-2173. [PMID: 34839405 DOI: 10.1007/s00405-021-07184-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Compare awake evaluation (modified Mallampati score-MMs, Müller maneuver-MM) to drug-induced sleep endoscopy (DISE) findings according to NOHL (nose-oropharynx-hypopharynx-larynx) classification in moderate-to-severe OSAHS patients. METHODS 43 moderate-to-severe OSAHS patients referred to our ENT department were enrolled over a 2-year period. In this observational prospective study, each patient was evaluated by the same ENT team both in wakefulness and during pharmacologically induced sleep. Level and severity of the obstruction were described. RESULTS The comparison of degree of collapsibility was statistically significative only at hypopharyngeal level: 41.8% of the patients showed a hypopharyngeal obstruction in wakefulness whereas 88.3% in DISE (p = 0.000). Laryngeal level was found in 18.6% patients during awake examination, conversely DISE demonstrated laryngeal obstruction in 4.6%. DISE identified significantly higher incidence of multilevel collapses (p = 0.001). However, the incidence of oropharyngeal obstruction in patients classified as MMs I and II was significantly higher in DISE compared to MM (p = 0.021). CONCLUSION DISE is the best predictor of hypopharyngeal obstruction, whereas MM underestimates the severity of the collapse at this level. DISE is more reliable than MM to identify the obstruction in patients with MMs score I and II.
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Affiliation(s)
- Ilaria Bindi
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
| | - Michele Ori
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
| | - Mauro Marchegiani
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
| | - Maddalena Morreale
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
| | - Luigi Gallucci
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
| | - Giampietro Ricci
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
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Cohen O, John MM, Kaufman AE, Kundel V, Burschtin O, Khan S, Fayad Z, Mani V, Shah NA. Novel non-invasive assessment of upper airway inflammation in obstructive sleep apnea using positron emission tomography/magnetic resonance imaging. Sleep Breath 2021; 26:1087-1096. [PMID: 34448065 DOI: 10.1007/s11325-021-02480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To develop a novel non-invasive technique to quantify upper airway inflammation using positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with obstructive sleep apnea (OSA). METHODS Patients with treatment naïve moderate-to-severe OSA underwent [18F]-fluoro-2-deoxy-D-glucose (FDG) PET/MRI. Three readers independently performed tracings of the pharyngeal soft tissue on MRI. Standardized uptake values (SUV) were generated from region of interest (ROI) tracings on corresponding PET images. Background SUV was measured from the sternocleidomastoid muscle. SUV and target-to-background (TBR) were compared across readers using intraclass correlation coefficient (ICC) analyses. SUV from individual image slices were compared between each reader using Bland-Altman plots and Pearson correlation coefficients. All tracings were repeated by one reader for assessment of intra-reader reliability. RESULTS Five participants completed our imaging protocol and analysis. Median age, body mass index, and apnea-hypopnea index were 41 years (IQR 40.5-68.5), 32.7 kg/m2 (IQR 28.1-38.1), and 30.7 event per hour (IQR 19.5-48.1), respectively. The highest metabolic activity regions were consistently localized to palatine or lingual tonsil adjacent mucosa. Twenty-five ICC met criteria for excellent agreement. The remaining three were TBR measurements which met criteria for good agreement. Head-to-head comparisons revealed strong correlation between each reader. CONCLUSIONS Our novel imaging technique demonstrated reliable quantification of upper airway FDG avidity. This technology has implications for future work exploring local airway inflammation in individuals with OSA and exposure to pollutants. It may also serve as an assessment tool for response to OSA therapies.
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Affiliation(s)
- Oren Cohen
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Mira M John
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Audrey E Kaufman
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vaishnavi Kundel
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Omar Burschtin
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samira Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Venkatesh Mani
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Neomi A Shah
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Sebastian A, Cistulli PA, Cohen G, de Chazal P. Association of Snoring Characteristics with Predominant Site of Collapse of Upper Airway in Obstructive Sleep Apnoea Patients. Sleep 2021; 44:6322655. [PMID: 34270768 DOI: 10.1093/sleep/zsab176] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/11/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Acoustic analysis of isolated events and snoring by previous researchers suggests a correlation between individual acoustic features and individual site of collapse events. In this study, we hypothesised that multi-parameter evaluation of snore sounds during natural sleep would provide a robust prediction of the predominant site of airway collapse. METHODS The audio signals of 58 OSA patients were recorded simultaneously with full night polysomnography. The site of collapse was determined by manual analysis of the shape of the airflow signal during hypopnoea events and corresponding audio signal segments containing snore were manually extracted and processed. Machine learning algorithms were developed to automatically annotate the site of collapse of each hypopnoea event into three classes (lateral wall, palate and tongue-base). The predominant site of collapse for a sleep period was determined from the individual hypopnoea annotations and compared to the manually determined annotations. This was a retrospective study that used cross-validation to estimate performance. RESULTS Cluster analysis showed that the data fits well in two clusters with a mean silhouette coefficient of 0.79 and an accuracy of 68% for classifying tongue/non-tongue collapse. A classification model using linear discriminants achieved an overall accuracy of 81% for discriminating tongue/non-tongue predominant site of collapse and accuracy of 64% for all site of collapse classes. CONCLUSIONS Our results reveal that the snore signal during hypopnoea can provide information regarding the predominant site of collapse in the upper airway. Therefore, the audio signal recorded during sleep could potentially be used as a new tool in identifying the predominant site of collapse and consequently improving the treatment selection and outcome.
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Affiliation(s)
- Arun Sebastian
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Peter A Cistulli
- Charles Perkins Centre, The University of Sydney, Sydney, Australia.,Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Sleep Investigation Laboratory, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Gary Cohen
- Sleep Investigation Laboratory, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Philip de Chazal
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia
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Vinha PP, Thuler ER, de Mello-Filho FV. Effects of surgically assisted rapid maxillary expansion on the modification of the pharynx and hard palate and on obstructive sleep apnea, and their correlations. J Craniomaxillofac Surg 2020; 48:339-348. [PMID: 32169348 DOI: 10.1016/j.jcms.2020.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/20/2020] [Accepted: 02/14/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate the changes induced by surgically assisted rapid maxillary expansion (SARME) on palate and pharynx morphology as well as the correlation of these changes with the improvement of obstructive sleep apnea (OSA). MATERIALS AND METHODS The study was conducted in 16 patients, seven women and nine men, aged on average 40.23 ± 10.23 years, all of them with OSA confirmed by polysomnography (PSG) and with posterior crossbite. All participants underwent computed tomography (CT) and PSG before and after SARME. The CT scans were used to determine the dimensions of the palate and pharynx before and after surgery. Data were analyzed statistically by the paired t-test, Wilcoxon test and Pearson correlation, with the level of significance set at P < 0.05. RESULTS A 56.24% reduction in apnea and hypopnea index was detected (from 33.23 ± 39.54 to 14.54 ± 19.48: P = 0.001). The total airway area increased on average by 23.99% (P = 0.016), although in a more expressive manner in its lower half (28.63%, P = 0.008). A 24% transverse bone increase was observed in the palate in the region of the first premolars and an 18% increase in the region of the first molars (from 2.42 ± 0.31 to 2.99 ± 0.26. P < 0.001, and from 3.11 ± 0.32 to 3.70 ± 0.41, P < 0.001, respectively), and a mean 15% reduction of its depth (from 1.07 ± 0.33 to 0.89 ± 0.18, P = 0.014). A moderate correlation was detected between palate depth and width and OSA severity, as well as a correlation of the reduction of palate depth and its transverse increase with the improvement of OSA, especially among patients with severe OSA. CONCLUSION It appears that narrowing of the palate, especially in the premolar region, and its greater depth may be related to the severity of OSA. SARME promotes transverse maxillary widening and lowering of palate depth, thus reducing OSA among adults and expanding the airway, especially in its lower half.
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Abstract
RATIONALE The use of real-time magnetic resonance imaging (MRI) for the evaluation during sleep-related respiratory events can lead to better understanding of airway dynamics. OBJECTIVES To investigate the dynamic anatomy of the upper airway during central apnea. METHODS The study included obese adolescents who snore and were otherwise healthy. Subjects underwent an overnight baseline polysomnogram. Subjects slept during a 24-minute real-time upper airway MRI scan wearing a full face mask attached to a pneumotach. Sleep versus wakefulness during the MRI was inferred from the heart rate and respiratory patterns. Central apneas were scored using tracings of facemask airflow and abdominal bellows. The cross-sectional area of the upper airway before, during, and after each central apnea event was recorded. RESULTS Eight subjects were studied and 57 central apnea events were observed during real-time MRI scanning during natural sleep. The median age of subjects was 14.0 years (interquartile range [IQR], 13.5 to 15.5). The median average reduction in cross-sectional area during central apnea events was -38% (IQR, -27 to -51) for primary snorers and -45% (IQR, -40 to -54) for subjects with obstructive sleep apnea. The percentage decrease in cross-sectional area of upper airway during a central apnea event was positively correlated to the length of the central apnea (ρ = 0.389; r2 = 0.152; P = 0.003). CONCLUSIONS We observed that there is upper airway narrowing during central apneas during natural sleep in obese adolescent subjects, using real-time MRI.
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Passos UL, Genta PR, Marcondes BF, Lorenzi-Filho G, Gebrim EMMS. State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea. ACTA ACUST UNITED AC 2019; 45:e20180264. [PMID: 31432889 PMCID: PMC6733715 DOI: 10.1590/1806-3713/e20180264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/23/2019] [Indexed: 12/02/2022]
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.
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Affiliation(s)
- Ula Lindoso Passos
- . Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Pedro Rodrigues Genta
- . Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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14
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A Novel Grading System for Salpingopharyngeal Fold Hypertrophy in Obstructive Sleep Apnoea. Indian J Otolaryngol Head Neck Surg 2019; 71:60-65. [PMID: 30906715 DOI: 10.1007/s12070-018-1513-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022] Open
Abstract
The present study aimed at reporting the incidence of Salpingopharyngeal Fold (SPF) hypertrophy on Drug Induced Sleep Endoscopy (DISE) in patients with Obstructive Sleep Apnoea (OSA, validate a grading system and analyse the impact of various grades on the clinical presentation while ascertaining its relation with Apnoea-Hypopnoea Index (AHI). A retrospective analysis of 169 patients with polysomnographic confirmation of obstructive sleep apnoea has been done in the study. The DISE video data of 169 patients was evaluated by two ENT surgeons individually and they graded the hypertrophy of the fold as Grade 0 being normal anatomy, Grade 1 being hypertrophy causing partial obstruction and Grade 2 being hypertrophy causing complete obstruction of lateral pharyngeal wall. It was found that the presence of SPF hypertrophy independently adds considerably to the severity of the obstruction, attributing to lateral collapse at the upper retropalatal level and also significantly increases AHI. It is thus advised to consider the grade of SPF hypertrophy while surgically planning the management of patients with OSA.
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15
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Kim YC. Fast upper airway magnetic resonance imaging for assessment of speech production and sleep apnea. PRECISION AND FUTURE MEDICINE 2018. [DOI: 10.23838/pfm.2018.00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Prediction of tongue obstruction observed from drug induced sleep computed tomography by cephalometric parameters. Auris Nasus Larynx 2018; 46:384-389. [PMID: 30262210 DOI: 10.1016/j.anl.2018.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/15/2018] [Accepted: 08/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To elucidate potential role of cephalometric measurements to predict tongue base obstruction as observed on drug Induced Sleep Computed Tomography (DIS-CT). METHODS Study included 35 patients with moderate to severe sleep apnea who underwent DIS-CT & cephalometric examination to assess tongue base obstruction. RESULTS Statistically significant difference was noted for SNA angle & Mandibular posterior airway space (PAS) among groups with total tongue obstruction versus Non-total tongue obstruction identified on DIS-CT. CONCLUSION Lateral cephalogram can be used as a standard screening tool with commonly used skeletal and soft tissue parameters to predict the possibility of tongue collapse/obstruction during sleep in patient with moderate to severe OSAS.
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Darquenne C, Elliott AR, Sibille B, Smales ET, DeYoung PN, Theilmann RJ, Malhotra A. Upper airway dynamic imaging during tidal breathing in awake and asleep subjects with obstructive sleep apnea and healthy controls. Physiol Rep 2018; 6:e13711. [PMID: 29845763 PMCID: PMC5974719 DOI: 10.14814/phy2.13711] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023] Open
Abstract
We used magnetic resonance imaging (MRI) to quantify change in upper airway dimension during tidal breathing in subjects with obstructive sleep apnea (OSA, N = 7) and BMI-matched healthy controls (N = 7) during both wakefulness and natural sleep. Dynamic MR images of the upper airway were obtained on a 1.5 T MR scanner in contiguous 7.5 mm-thick axial slices from the hard palate to the epiglottis along with synchronous MRI-compatible electroencephalogram and nasal/oral flow measurements. The physiologic data were retrospectively scored to identify sleep state, and synchronized with dynamic MR images. For each image, the upper airway was characterized by its area, and linear dimensions (lateral and anterior-posterior). The dynamic behavior of the upper airway was assessed by the maximum change in these parameters over the tidal breath. Mean upper airway caliber was obtained by averaging data over the tidal breath. There was no major difference in the upper airway structure between OSA and controls except for a narrower airway at the low-retropalatal/high-retroglossal level in OSA than in controls. Changes in upper airway size over the tidal breath ((maximum - minimum)/mean) were significantly larger in the OSA than in the control group in the low retropalatal/high retroglossal region during both wakefulness and sleep. In the four OSA subjects who experienced obstructive apneas during MR imaging, the site of airway collapse during sleep corresponded to the region of the upper airway where changes in caliber during awake tidal breathing were the greatest. These observations suggest a potential role for dynamic OSA imaging during wakefulness.
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Affiliation(s)
| | - Ann R. Elliott
- Division of PhysiologyUniversity of CaliforniaSan DiegoCalifornia
| | - Bastien Sibille
- Division of PhysiologyUniversity of CaliforniaSan DiegoCalifornia
| | - Erik T. Smales
- Division of PulmonaryCritical Care and Sleep MedicineUniversity of CaliforniaSan DiegoCalifornia
| | - Pamela N. DeYoung
- Division of PulmonaryCritical Care and Sleep MedicineUniversity of CaliforniaSan DiegoCalifornia
| | | | - Atul Malhotra
- Division of PulmonaryCritical Care and Sleep MedicineUniversity of CaliforniaSan DiegoCalifornia
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Imaging of adult obstructive sleep apnoea. Eur J Radiol 2018; 102:176-187. [PMID: 29685533 DOI: 10.1016/j.ejrad.2018.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/26/2018] [Accepted: 03/05/2018] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnoea (OSA) is characterised by recurrent upper airway collapse during sleep resulting in chronic and repetitive hypoxia, hypercapnia, subsequent arousal and fragmented sleep. Symptoms are insidious and diagnosis is usually delayed. Moderate to severe OSA has serious health implications with significant increase in all causes of mortality in patients with the condition as compared with unaffected individuals. The prevalence of OSA in the 30-70 year age group is estimated at 27% of males and 11% of females and it increases with age. 80% of affected individuals are obese and as obesity rates rise, so has the prevalence of OSA. An overnight polysomnogram (PSG) is required for a definitive diagnosis of OSA. Imaging has played a fundamental role in the evaluation of the anatomical factors associated with recurrent upper airway collapse and the pathogenesis of OSA. The upper airway is frequently imaged by radiologists, providing an opportunity to detect features that are strongly associated with unsuspected OSA and to raise the possibility of this diagnosis. The gold standard of treatment is continuous positive airway pressure (CPAP) which acts as a pneumatic splint for the upper airway. However, efficacy is frequently limited by poor tolerance; clinicians and patients are increasingly opting for one of a range of surgical procedures. Dedicated imaging protocols can be performed for evaluation of the upper airway to aid surgical planning.
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Huon LK, Liu SYC, Shih TTF, Chen YJ, Lo MT, Wang PC. Dynamic upper airway collapse observed from sleep MRI: BMI-matched severe and mild OSA patients. Eur Arch Otorhinolaryngol 2016; 273:4021-4026. [PMID: 27276991 DOI: 10.1007/s00405-016-4131-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 05/31/2016] [Indexed: 01/24/2023]
Abstract
Dynamic magnetic resonance imaging (MRI) allows real-time characterization of upper airway collapse in sleeping subjects with obstructive sleep apnea (OSA). The aim of our study was to use sleep MRI to compare differences in upper airway collapse sites between BMI-matched subjects with mild OSA and severe OSA. This is a prospective, nested case-control study using dynamic sleep MRI to compare 15 severe OSA subjects (AHI >40) and 15 mild OSA (AHI <10) subjects, who were matched for BMI. Upper airway imaging was performed on sleeping subjects in a 3.0 T MRI scanner. Sleep MRI movies were used by blinded reviewers to identify retropalatal (RP), retroglossal (RG), and lateral pharyngeal wall (LPW) airway collapse. Mean AHI in the severe OSA group was 70.3 ± 23 events/h, and in the mild group was 7.8 ± 1 events/h (p < 0.001). All mild and severe OSA subjects demonstrated retropalatal airway collapse. Eighty percent in the mild group showed single-level RP collapse (p < 0.001). All subjects in the severe group showed multi-level collapse: RP + LPW (n = 9), RP + RG + LPW (n = 6). All severe OSA subjects showed LPW collapse, as compared with three subjects in the mild group (p < 0.001). LPW collapse was positively associated with AHI in simple regression analysis (β = 51.8, p < 0.001). In conclusion, severe OSA patients present with more lateral pharyngeal wall collapse as compared to BMI-matched mild OSA patients.
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Affiliation(s)
- Leh-Kiong Huon
- Department of Otolaryngology-Head and Neck Surgery, Cathay General Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.,Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Yunn-Jy Chen
- Department of Dental Medicine, National Taiwan University, Taipei, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Pa-Chun Wang
- Department of Otolaryngology-Head and Neck Surgery, Cathay General Hospital, Taipei, Taiwan. .,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
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Drug-induced sedation endoscopy versus clinical exploration for the diagnosis of severe upper airway obstruction in OSAHS patients. Sleep Breath 2015; 19:1367-72. [PMID: 26449550 DOI: 10.1007/s11325-015-1266-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 09/05/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Identifying the sites of obstruction of the upper airway in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) is paramount for surgical planning. The aim of this study is to compare wake physical exam findings to the ones obtained during drug-induced sedation endoscopy (DISE) in the diagnosis of severe collapse of the upper airway in OSAHS patients. METHODS A retrospective chart review of OSAHS patients who underwent DISE at our institution during the 2006-2010 period was conducted. All the patients had previously undergone a physical examination that included modified Mallampati index (MMI), the Müller maneuver (MM), and the Friedman staging system. Level and severity of airway collapse were evaluated. A severe collapse was attributed to obstructions equal or greater than 75 % of the airway. RESULTS A total of 138 patients were included in the study. The incidence of severe airway collapse was compared between DISE and MM; at retropalatal level, no significant difference was found. At retrolingual level, 69 % of patients had severe collapse with DISE in comparison to a 28 % with the MM (p < 0.05). No relationship was found either with the MMI or with the Friedman staging system when compared to the incidence of severe retrolingual collapse diagnosed by DISE. Concordance was low between awake and DISE exploration in both retropalatal and retroglossal level. CONCLUSION The Müller maneuver underestimates tongue base severe obstruction diagnosis when compared to that obtained after DISE in OSAHS patients. The wake patient exploration does not accurately correlate to DISE exploration.
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