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Role of dynamic sleep MRI in obstructive sleep apnea syndrome. Oral Radiol 2020; 37:376-384. [PMID: 32556868 DOI: 10.1007/s11282-020-00455-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To identify obstruction sites of the upper airway during sleep in patients with obstructive sleep apnea syndrome (OSAS) under dynamic conditions and improve knowledge to guide surgical treatment and advancements. MATERIALS AND METHODS The study included 15 patients (5 females and 10 males) who were diagnosed as having OSAS. Overall mean age was 40.2 years (± 7.01 years). All the patients underwent drug-induced sleep endoscopy (DISE) and dynamic sleep MRI. The presence, location, and direction of airway collapse were assessed. Dynamic MRI findings were correlated to DISE. Data of the site and direction of airway collapse were correlated with those of endoscopic findings and interobserver agreement was done. RESULTS The dynamic images in sagittal section showed collapse of the upper airway at retropalatal level in 14 patients (93.33%) and at retroglossal level in seven patients (46.7%) and of these 14 patients; seven had combined retropalatal and retroglossal collapse. These findings were highly correlated with DISE findings with an excellent interobserver agreement for retropalatal and retroglossal levels (Kappa = 1 and 0.867, P value = 0.000), respectively. Objective measurements of the direction of collapse in axial dynamic sleep MRI images showed significant statistical correlation with endoscopic findings regarding retropalatal anteroposterior and circumferential collapse (Kappa = 0.58 and 0.52, P value = 0.02 and 0.03, respectively). CONCLUSION Dynamic sleep MRI can reliably characterize the actual site of dynamic airway obstruction and has the potential of improving predictions of successful surgical outcomes in OSAS patients.
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Zeng G, Teng Y, Zhu J, Zhu D, Yang B, Hu L, Chen M, Fu X. Clinical application of MRI-respiratory gating technology in the evaluation of children with obstructive sleep apnea hypopnea syndrome. Medicine (Baltimore) 2018; 97:e9680. [PMID: 29369187 PMCID: PMC5794371 DOI: 10.1097/md.0000000000009680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of the present study was to investigate the clinical application of magnetic resonance imaging (MRI)-respiratory gating technology for assessing illness severity in children with obstructive sleep apnea hypopnea syndrome (OSAHS).MRI-respiratory gating technology was used to scan the nasopharyngeal cavities of 51 children diagnosed with OSAHS during 6 respiratory phases. Correlations between the ratio of the area of the adenoid to the area of the nasopalatine pharyngeal cavity (Sa/Snp), with the main indexes of polysomnography (PSG), were analyzed. Receiver operator characteristic (ROC) curve and Kappa analysis were used to determine the diagnostic accuracy of Sa/Snp in pediatric OSAHS.The Sa/Snp was positively correlated with the apnea hypopnea index (AHI) (P < .001) and negatively correlated with the lowest oxygen saturation of blood during sleep (LaSO2) (P < .001). ROC analysis in the 6 respiratory phases showed that the area under the curve (AUC) of the Sa/Snp in the end-expiratory phase was the largest (0.992, P < .001), providing a threshold of 69.5% for the diagnosis of severe versus slight-moderate OSAHS in children. Consistency analysis with the AHI showed a diagnosis accordance rate of 96.0% in severe pediatric OSAHS and 96.2% in slight-moderate pediatric OSAHS (Kappa = 0.922, P < .001).Stenosis of the nasopalatine pharyngeal cavity in children with adenoidal hypertrophy was greatest at the end-expiration phase during sleep. The end-expiratory Sa/Snp obtained by a combination of MRI and respiratory gating technology has potential as an important imaging index for diagnosing and evaluating severity in pediatric OSAHS.
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Affiliation(s)
- Guohui Zeng
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Yaoshu Teng
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Jin Zhu
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Darong Zhu
- Department of Radiology, Hangzhou First People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Yang
- Department of Radiology, Hangzhou First People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Linpin Hu
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Manman Chen
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Xiao Fu
- Department of Otorhinolaryngology Head and Neck Surgery
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Lee LA, Lo YL, Yu JF, Lee GS, Ni YL, Chen NH, Fang TJ, Huang CG, Cheng WN, Li HY. Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome. Sci Rep 2016; 6:30629. [PMID: 27471038 PMCID: PMC4965759 DOI: 10.1038/srep30629] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/06/2016] [Indexed: 11/09/2022] Open
Abstract
Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40-300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05-1.49) and body mass index (OR, 1.48, 95% CI 1.02-2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301-850 Hz; OR, 0.84, 95% CI 0.74-0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301-850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses.
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Affiliation(s)
- Li-Ang Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC
| | - Yu-Lun Lo
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC.,Department of Thoracic Medicine, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC
| | - Jen-Fang Yu
- Graduate Institute of Medical Mechatronics, Taiouan Interdisciplinary Otolaryngology Laboratory, Chang Gung University, Taoyuan 33303, Taiwan
| | - Gui-She Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan, ROC.,Department of Otolaryngology, Taipei City Hospital, Ren-Ai Branch, Taipei 10629, Taiwan, ROC
| | - Yung-Lun Ni
- Department of Thoracic Medicine, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Department of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan, ROC
| | - Ning-Hung Chen
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC.,Department of Thoracic Medicine, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Tao-Yuan 33303, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Tao-Yuan 33303, Taiwan, ROC
| | - Wen-Nuan Cheng
- Department of Sports Sciences, University of Taipei, Tai-Pei 11153, Taiwan, ROC
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC.,Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
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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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