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Kumar D, Woodson BT, Garcia GJM. Phenotypes of Velopharyngeal Tube Law in Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2024. [PMID: 39360341 DOI: 10.1002/ohn.997] [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: 05/04/2024] [Revised: 09/05/2024] [Accepted: 09/15/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVE The biomechanics of upper airway collapse in obstructive sleep apnea (OSA) remains poorly understood. The goal of this study is to compare the area-pressure relationship (tube law) of the velopharynx at peak inspiration and peak expiration. STUDY DESIGN Cross-sectional. SETTING Academic tertiary medical center. METHODS The velopharyngeal tube law was quantified in a convenience sample of 20 OSA patients via step reductions in nasal mask pressure during drug induced sleep endoscopy (DISE). The velopharyngeal airspace cross-sectional area was estimated from endoscopy while luminal pressure was recorded with a catheter. The tube law was quantified for nasal mask pressures from 14 to 0 cmH2O at peak inspiration and at peak expiration in all patients. The tube law was also quantified during the breathing cycle at a constant nasal mask pressure of 4 cmH2O in 3 patients representing different phenotypes. RESULTS Velopharyngeal compliance (the slope of the tube law) was not statistically different in the peak inspiration versus peak expiration tube laws. Three phenotypes were observed, namely inspiratory collapse (phenotype 1), expiratory collapse (phenotype 2 = palatal prolapse), and a mostly stable airway during inspiration and expiration that collapsed as CPAP was reduced (phenotype 3). CONCLUSION Velopharyngeal compliance is not significantly different at peak inspiration and peak expiration, which suggests that muscle tone is low when luminal pressure is above the closing pressure. Additional studies are needed to investigate how different phenotypes of velopharyngeal collapse may affect therapeutic outcomes.
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Affiliation(s)
- Devesh Kumar
- Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, Milwaukee, USA
- Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, Milwaukee, USA
| | - B Tucker Woodson
- Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, Milwaukee, USA
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, Milwaukee, USA
- Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, Milwaukee, USA
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Yu Y, Xia X, Xu L, Chen X, Zhang N, Wu M. Correlation analysis of airway space and condylar morphology in bilateral idiopathic condylar resorption patients. Orthod Craniofac Res 2024. [PMID: 39277820 DOI: 10.1111/ocr.12855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 08/10/2024] [Accepted: 08/26/2024] [Indexed: 09/17/2024]
Abstract
To evaluate the airway space in bilateral idiopathic condylar resorption (ICR) patients and analyse the correlation between the morphological characteristics of the condyles and airway parameters. In all, 35 female patients with bilateral ICR (mean age: 21.6 years) and 35 age-matched female controls (mean age: 21.3 years) were included. Airway parameters were measured using CBCT. Independent T-tests were used to analyse the differences between the bilateral ICR group and the control group, and then the correlation between airway parameters and condylar parameters was detected using Pearson correlation analysis. p < .05 was considered statistically significant. Patients with bilateral ICR showed a significant decrease in airway volume, minimum axial area and sagittal sectional area (p < .05). The bilateral condylar axial angle positively correlated with airway volume and sagittal sectional area (p < .05). In contrast, the bilateral condylar neck angle negatively correlated with sagittal sectional area (p < .05). None of the condylar parameters showed a correlation with minimum axial area of the airway in the bilateral ICR group (p > .05). Bilateral ICR significantly affects patients' airway space. The condylar axial angle and neck angle correlate with airway parameters.
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Affiliation(s)
- Yanfang Yu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Xueyan Xia
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Lehan Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Xiaoyan Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Ningning Zhang
- Department of Stomatology, Wu Xing District People's Hospital, Huzhou, Zhejiang, China
| | - Mengjie Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
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3
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Messineo L, Bakker JP, Cronin J, Yee J, White DP. Obstructive sleep apnea and obesity: A review of epidemiology, pathophysiology and the effect of weight-loss treatments. Sleep Med Rev 2024; 78:101996. [PMID: 39244884 DOI: 10.1016/j.smrv.2024.101996] [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: 02/13/2024] [Revised: 08/13/2024] [Accepted: 08/23/2024] [Indexed: 09/10/2024]
Abstract
Despite the commonly-accepted paradigm that patients with obstructive sleep apnea (OSA) also invariably have obesity, OSA prevalence extends beyond obesity. This necessitates a reevaluation of screening strategies, biomarkers of increased OSA risk, and heightened awareness among healthcare providers about the array of OSA treatments for diverse adult populations. While obesity contributes importantly to OSA pathogenesis, there is substantial evidence that non-anatomical factors also play a crucial role, especially in patients who do not have obesity. In recent years, notwithstanding the recognition of diverse contributors to OSA pathogenesis, research has frequently focused on weight reduction to address OSA. Insights from past experiences with bariatric surgery in OSA serve as a lens to anticipate potential outcomes of emerging anti-obesity pharmacotherapies. Pharmacological alternatives, particularly incretin agonists, exhibit promise in weight reduction and OSA improvement, but encounter obstacles such as potential side effects and high costs. With this comprehensive narrative review, we delve into the complex epidemiological and pathophysiological connections between OSA and obesity. Additionally, we emphasize the importance of a multifaceted approach to OSA treatment, recognizing that while weight management is crucial, there is a need for comprehensive strategies that go beyond traditional weight-centric perspectives.
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Affiliation(s)
- Ludovico Messineo
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA.
| | - Jessie P Bakker
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | | | | | - David P White
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
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Sayir TN, Tuncer B, Erkilic E. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population. Open Med (Wars) 2024; 19:20241013. [PMID: 39176250 PMCID: PMC11340856 DOI: 10.1515/med-2024-1013] [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: 02/08/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 08/24/2024] Open
Abstract
Objectives Studies have shown that there are differences in clinical evaluation parameters and difficult intubation rates among different ethnic populations. In our study, we aimed to evaluate the efficacy of upper airway clinical and ultrasonographic measurement methods in Turkish population. Methods Our study is a single-center, prospective, observational study conducted with 402 patients. All patients underwent clinical airway measurements which are routinely used in pre-anesthetic evaluation. In addition, ultrasonographic anterior neck soft tissue thickness measurements of each patient were made and recorded. Results Among the clinical measurements, we found the neck circumference/thyromental distance (TMD) ratio to be significant with a cut-off value of 5.5 and a sensitivity of 92.9% and a specificity of 88.3%, while among the ultrasonographic anterior neck measurements, we found the skin-epiglottic distance to be the most sensitive measurement. We found that there was a positive relationship between the neck circumference/TMD ratio and skin-epiglottis. Conclusions In our study, we found that routine measurement methods used in airway examination alone are not sufficient, and measurements that take into account the body proportions of the patients, such as the neck circumference/TMD ratio and the ultrasonographic evaluations are more useful in predicting difficult intubation.
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Affiliation(s)
- Tugba Nur Sayir
- Ankara City Hospital, Anesthesiology and Reanimation, Ankara, Turkey
| | - Bilge Tuncer
- Ankara City Hospital, Anesthesiology and Reanimation, Ankara, Turkey
| | - Ezgi Erkilic
- Ankara City Hospital, Anesthesiology and Reanimation, Ankara, Turkey
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Shi X, Chen H, Lobbezoo F, de Lange J, van der Stelt P, Berkhout E, Guo J, Ge S, Li G, Li Y, Aarab G. Comparison of the upper airway morphology between Dutch and Chinese adults with obstructive sleep apnea. Sleep Breath 2023; 27:2223-2230. [PMID: 37093512 PMCID: PMC10656314 DOI: 10.1007/s11325-023-02834-z] [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: 09/08/2022] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The pathogenesis of obstructive sleep apnea (OSA) is complex and may vary between different races. It has been suggested that the anatomical balance between skeletal tissues and soft tissues around the upper airway is a key pathophysiologic factor of OSA. Therefore, the aim of this study was to compare the anatomical balance of the upper airway between Dutch and Chinese patients with OSA based on cone beam computed tomography (CBCT) images. METHODS This was a cross-sectional study performed in two centers and included Dutch and Chinese adults with OSA. CBCT scans in the supine position were obtained for both Dutch and Chinese OSA groups. The primary outcome variable was the anatomical balance of the upper airway, defined as the ratio of the tongue area and the maxillomandibular enclosure area. RESULTS A total of 28 Dutch adults (mean age ± SD of 46.6 ± 14.1 years, body mass index [BMI] of 26.8 ± 3.5 kg/m2, and apnea-hypopnea index [AHI] of 15.7 ± 7.1 events/h) and 24 Chinese adults (age 41.0 ± 12.4 years, BMI 26.5 ± 3.3 kg/m2, and AHI 16.5 ± 7.8 events/h). There were no significant differences in AHI, age, BMI, and sex between the two groups (P = 0.14-0.76). The Dutch group had a significantly larger tongue area and tongue length compared to the Chinese group (P = 0.01 and P < 0.01). On the other hand, the Chinese group had a smaller maxilla length compared to the Dutch group (P < 0.01). However, the anatomical balance of the upper airway of both groups was not significantly different (P = 0.16). CONCLUSION Within the limitations of this study, no significant difference was found in the anatomical balance of the upper airway between Dutch and Chinese patients with mild to moderate OSA. TRIAL REGISTRATION The present study was registered at the ClinicalTrials.gov identifier NCT03463785.
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Affiliation(s)
- Xiaoxin Shi
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Hui Chen
- Department of Orthodontics and Periodontics and Oral Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road west, Jinan, 250012, China.
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Paul van der Stelt
- Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erwin Berkhout
- Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jing Guo
- Department of Orthodontics and Periodontics and Oral Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road west, Jinan, 250012, China
| | - Shaohua Ge
- Department of Orthodontics and Periodontics and Oral Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road west, Jinan, 250012, China
| | - Guoju Li
- Department of Orthodontics and Periodontics and Oral Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road west, Jinan, 250012, China
| | - Yanzhong Li
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology, Jinan, China
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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He S, Li Y, Zhang C, Li Z, Ren Y, Li T, Wang J. Deep learning technique to detect craniofacial anatomical abnormalities concentrated on middle and anterior of face in patients with sleep apnea. Sleep Med 2023; 112:12-20. [PMID: 37801860 DOI: 10.1016/j.sleep.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/17/2023] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES The aim of this study is to propose a deep learning-based model using craniofacial photographs for automatic obstructive sleep apnea (OSA) detection and to perform design explainability tests to investigate important craniofacial regions as well as the reliability of the method. METHODS Five hundred and thirty participants with suspected OSA are subjected to polysomnography. Front and profile craniofacial photographs are captured and randomly segregated into training, validation, and test sets for model development and evaluation. Photographic occlusion tests and visual observations are performed to determine regions at risk of OSA. The number of positive regions in each participant is identified and their associations with OSA is assessed. RESULTS The model using craniofacial photographs alone yields an accuracy of 0.884 and an area under the receiver operating characteristic curve of 0.881 (95% confidence interval, 0.839-0.922). Using the cutoff point with the maximum sum of sensitivity and specificity, the model exhibits a sensitivity of 0.905 and a specificity of 0.941. The bilateral eyes, nose, mouth and chin, pre-auricular area, and ears contribute the most to disease detection. When photographs that increase the weights of these regions are used, the performance of the model improved. Additionally, different severities of OSA become more prevalent as the number of positive craniofacial regions increases. CONCLUSIONS The results suggest that the deep learning-based model can extract meaningful features that are primarily concentrated in the middle and anterior regions of the face.
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Affiliation(s)
- Shuai He
- Department of Otolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, China
| | - Yingjie Li
- School of Computer Science and Engineering, Beijing Technology and Business University, China
| | - Chong Zhang
- Department of Big Data Management and Application, School of International Economics and Management, Beijing Technology and Business University, China
| | - Zufei Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, China
| | - Yuanyuan Ren
- Department of Otolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, China
| | - Tiancheng Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, China.
| | - Jianting Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, 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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Park JS, Kwon B, Kang HS, Yun SJ, Han SJ, Choi Y, Kang SH, Lee MY, Lee KC, Hong SJ. Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence. J Pers Med 2023; 13:1196. [PMID: 37623447 PMCID: PMC10455729 DOI: 10.3390/jpm13081196] [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: 06/23/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Positive airway pressure (PAP) is an important treatment tool for patients with moderate and severe obstructive sleep apnea (OSA), and adherence to PAP significantly affects treatment outcomes. Disease severity, adverse effects, and psychosocial factors are known to predict medication adherence. Cephalometric parameters have been reported to positively correlate with upper airway collapse. However, research on the correlation between these cephalometric parameters and PAP adherence remains insufficient. This study aimed to identify this relationship. This study included 185 patients with OSA who were prescribed PAP. Polysomnography (PSG) was performed to diagnose OSA, and paranasal sinus computed tomography (PNS CT) was performed to check for comorbidities of the upper airway. In addition, cephalometric parameters such as the hyoid-posterior nasal spine (H-PNS), posterior nasal spine-mandibular plane (PNS-MP), and hyoid-mandibular plane (H-MP) were measured in the midsagittal and axial CT views. Adherence was evaluated 3-12 months after the PAP prescription. A total of 136 patients were PAP-adherent, and 49 were nonadherent. There were more males in the adherent group and a higher average height in the adherent group. The PSG results showed that the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), arousal index (AI), rapid eye movement (REM) AHI, and supine AHI were significantly higher, and the lowest oxygen saturation was lower in the adherent group. In the analysis of covariance (ANCOVA) model adjusted for sex and height, among the cephalometric parameters, H-MP was significantly longer in the adherent group (p = 0.027), and H-PNS showed a longer tendency (p = 0.074). In the logistic regression analysis model, the odds ratio (OR) and 95% confidence intervals (95% CI) of adherence and severe OSA in the third tertile compared to the first tertile of H-MP were 2.93 (1.25-6.86) and 4.00 (1.87-8.56). In the case of H-PNS, they were 2.58 (1.14-5.81) and 4.86 (2.24-10.54), respectively. This study concluded that an inferiorly placed hyoid bone in adult patients is associated with PAP adherence and disease severity.
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Affiliation(s)
- Jae-Seon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Bin Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea; (B.K.); (S.-J.H.); (Y.C.)
| | - Hyun-Seok Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Seong-Jin Yun
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Sung-Jun Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea; (B.K.); (S.-J.H.); (Y.C.)
| | - Yeso Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea; (B.K.); (S.-J.H.); (Y.C.)
| | - Sung-Hun Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Mi-Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
| | - Kyung-Chul Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Seok-Jin Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Begum NF, Ramani P. Gender-based cytomorphometric analysis of buccal exfoliated cells in a South Indian population. Cytopathology 2023; 34:361-366. [PMID: 37173830 DOI: 10.1111/cyt.13245] [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: 04/01/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To assess differences based on gender in nuclear area (NA), cytoplasmic area (CA), and nuclear-cytoplasmic ratio (N:C ratio) values for clinically normal buccal smears in apparently healthy subjects of a South Indian population, thereby providing definitive baseline cytomorphometric measurements for the South Indian population. METHODS Buccal smears were collected from 60 healthy subjects (30 males and 30 females) of a South Indian population above 18 years in age. Values of the NA and CA were measured, and the N:C ratio calculated, using ImageJ software. Statistical analysis of the data with independent t tests and 95% confidence intervals was done using SPSS version 21 (significance set at P < 0.05). RESULTS The results showed that there were significant differences in the NA, CA, and N:C values between males and females irrespective of age (P = 0.01). CONCLUSION Definitive gender-specific baseline cytomorphometric data can be established using exfoliative cytology for the South Indian population, and this may be helpful in deciphering the occurrence of oral pre-malignant diseases and oral squamous cell carcinoma in this population, as the incidence of these conditions varies with gender and different ethnic groups.
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Affiliation(s)
- N Fazulunnisa Begum
- Department of Oral and Maxillofacial Pathology, Saveetha Dental College and Hospitals, SIMATS, Chennai, India
| | - Pratibha Ramani
- Department of Oral and Maxillofacial Pathology, Saveetha Dental College and Hospitals, SIMATS, Chennai, India
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11
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Mohan Lal B, Vyas S, Malhotra A, Ray A, Gupta G, Pandey S, Pandey RM, Aggarwal S, Sinha S. Ultrasonography of the neck in patients with obstructive sleep apnea. Sleep Breath 2023; 27:903-912. [PMID: 35871215 PMCID: PMC9868188 DOI: 10.1007/s11325-022-02682-3] [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: 03/03/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION In resource-limited settings, obstructive sleep apnea (OSA) often goes undiagnosed as polysomnography (PSG) is expensive, time-consuming, and not readily available. Imaging studies of upper airway have been tried as alternatives to PSG to screen for OSA. However, racial differences in upper airway anatomy preclude generalizability of such studies. We sought to test the hypothesis that ultrasonography (USG), an inexpensive, readily available tool to study soft tissue structures of the upper airway, would have predictive value for OSA in South Asian people. METHODS Adult patients with sleep-related complaints suspicious for OSA were taken for overnight PSG. After the PSG, consecutive patients with and without OSA were studied with submental ultrasonography to measure tongue base thickness (TBT) and lateral pharyngeal wall thickness (LPWT). RESULTS Among 50 patients with OSA and 25 controls, mean age was 43.9 ± 11.4 years, and 39 were men. Patients with OSA had higher TBT (6.77 ± 0.63 cm vs 6.34 ± 0.54 cm, P value = 0.004) and higher LPWT (2.47 ± 0.60 cm vs 2.12 ± 0.26 cm, P value = 0.006) compared to patients without OSA. On multivariate analysis, TBT, LPWT, and neck circumference were identified as independent factors associated with OSA. These variables could identify patients with severe OSA with a sensitivity of 72% and a specificity of 76%. CONCLUSION Patients with OSA have higher tongue base thickness and lateral pharyngeal wall thickness proportionate to the severity of the disease, independent of BMI and neck circumference. These findings suggest that sub-mental ultrasonography may be useful to identify patients with severe OSA in resource-limited settings.
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Affiliation(s)
- Bhavesh Mohan Lal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Malhotra
- Critical Care and Sleep Medicine, UC San Diego School of Medicine, San Diego, CA, 92121, USA
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
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12
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D'Angelo GF, de Mello AAF, Schorr F, Gebrim E, Fernandes M, Lima GF, Grad GF, Yanagimori M, Lorenzi-Filho G, Genta PR. Muscle and visceral fat infiltration: A potential mechanism to explain the worsening of obstructive sleep apnea with age. Sleep Med 2023; 104:42-48. [PMID: 36871415 DOI: 10.1016/j.sleep.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
STUDY OBJECTIVES Aging is a major risk factor for obstructive sleep apnoea (OSA) and is associated with increased upper airway collapsibility, but the mechanisms are largely unknown. We hypothesized that the increase in OSA severity and upper airway collapsibility with age are partially mediated by upper airway, visceral and muscle fat infiltration. METHODS Male subjects underwent full polysomnography, upper airway collapsibility determination (Pcrit) after sleep induction with midazolam, upper airway and abdominal computed tomography. Tongue and abdominal muscle fat infiltration were assessed by the determination of muscle attenuation with computed tomography. RESULTS Eighty-four males with a wide range of age (47 ± 13 years, range 22-69 years) and apnea-hypopnea index (AHI) (30 [14-60] events/h, range 1-90 events/h), were studied. Younger and older males were grouped according to the mean age. Despite similar body mass-index (BMI), older subjects had higher AHI, higher Pcrit, larger neck and waist circumference, higher visceral and upper airway fat volumes (P < 0.01) as compared to younger subjects. Age was associated with OSA severity, Pcrit, neck and waist circumference, upper airway fat volume and visceral fat (P < 0.05), but not with BMI. Older subjects had lower tongue and abdominal muscle attenuation as compared to younger subjects (P < 0.001). Age was inversely associated with tongue and abdominal muscle attenuation, indicating muscle fat infiltration. CONCLUSIONS The associations between age, upper airway fat volume, visceral and muscle fat infiltration may help to explain the worsening of OSA and increased upper airway collapsibility with aging.
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Affiliation(s)
- Giovanna F D'Angelo
- Laboratorio do Sono, LIM 63, Divisão de Pneumologia, Instituto do Coração InCor, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - André A F de Mello
- Laboratorio do Sono, LIM 63, Divisão de Pneumologia, Instituto do Coração InCor, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fabiola Schorr
- Laboratorio do Sono, LIM 63, Divisão de Pneumologia, Instituto do Coração InCor, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eloisa Gebrim
- Instituto de Radiologia InRad, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mariana Fernandes
- Laboratorio do Sono, LIM 63, Divisão de Pneumologia, Instituto do Coração InCor, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Giovanni F Lima
- Laboratorio do Sono, LIM 63, Divisão de Pneumologia, Instituto do Coração InCor, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Gustavo F Grad
- Laboratorio do Sono, LIM 63, Divisão de Pneumologia, Instituto do Coração InCor, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcela Yanagimori
- Laboratorio do Sono, LIM 63, Divisão de Pneumologia, Instituto do Coração InCor, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Geraldo Lorenzi-Filho
- Laboratorio do Sono, LIM 63, Divisão de Pneumologia, Instituto do Coração InCor, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pedro Rodrigues Genta
- Laboratorio do Sono, LIM 63, Divisão de Pneumologia, Instituto do Coração InCor, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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13
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Augusto Bacelar de Athayde1 R, Luiz Igreja Colonna1 L, Schorr1 F, Maria Mello Santiago Gebrim2 E, Lorenzi-Filho1 G, Rodrigues Genta1 P. Tongue size matters: revisiting the Mallampati classification system in patients with obstructive sleep apnea. J Bras Pneumol 2023; 49:e20220402. [PMID: 37132703 PMCID: PMC10171301 DOI: 10.36416/1806-3756/e20220402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/28/2022] [Indexed: 02/10/2023] Open
Abstract
Objective: The Mallampati classification system has been used to predict obstructive sleep apnea (OSA). Upper airway soft tissue structures are prone to fat deposition, and the tongue is the largest of these structures. Given that a higher Mallampati score is associated with a crowded oropharynx, we hypothesized that the Mallampati score is associated with tongue volume and an imbalance between tongue and mandible volumes. Methods: Adult males underwent clinical evaluation, polysomnography, and upper airway CT scans. Tongue and mandible volumes were calculated and compared by Mallampati class. Results: Eighty patients were included (mean age, 46.8 years). On average, the study participants were overweight (BMI, 29.3 ± 4.0 kg/m2) and had moderate OSA (an apnea-hypopnea index of 26.2 ± 26.7 events/h). Mallampati class IV patients were older than Mallampati class II patients (53 ± 9 years vs. 40 ± 12 years; p < 0.01), had a larger neck circumference (43 ± 3 cm vs. 40 ± 3 cm; p < 0.05), had more severe OSA (51 ± 27 events/h vs. 24 ± 23 events/h; p < 0.01), and had a larger tongue volume (152 ± 19 cm3 vs. 135 ± 18 cm3; p < 0.01). Mallampati class IV patients also had a larger tongue volume than did Mallampati class III patients (152 ± 19 cm3 vs. 135 ± 13 cm3; p < 0.05), as well as having a higher tongue to mandible volume ratio (2.5 ± 0.5 cm3 vs. 2.1 ± 0.4 cm3; p < 0.05). The Mallampati score was associated with the apnea-hypopnea index (r = 0.431, p < 0.001), BMI (r = 0.405, p < 0.001), neck and waist circumference (r = 0.393, p < 0.001), tongue volume (r = 0.283, p < 0.001), and tongue/mandible volume (r = 0.280, p = 0.012). Conclusions: The Mallampati score appears to be influenced by obesity, tongue enlargement, and upper airway crowding.
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Affiliation(s)
- Rodolfo Augusto Bacelar de Athayde1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Leonardo Luiz Igreja Colonna1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Fabiola Schorr1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Geraldo Lorenzi-Filho1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Pedro Rodrigues Genta1
- 1. Laboratório do Sono – LIM 63 – Divisão de Pneumologia, Instituto do Coração – InCor – Hospital das Clínicas, Universidade de São Paulo, São Paulo (SP) Brasil
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Hartfield PJ, Janczy J, Sharma A, Newsome HA, Sparapani RA, Rhee JS, Woodson BT, Garcia GJM. Anatomical determinants of upper airway collapsibility in obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2022; 68:101741. [PMID: 36634409 DOI: 10.1016/j.smrv.2022.101741] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023]
Abstract
Upper airway (UA) collapsibility is one of the key factors that determine the severity of obstructive sleep apnea (OSA). Interventions for OSA are aimed at reducing UA collapsibility, but selecting the optimal alternative intervention for patients who fail CPAP is challenging because currently no validated method predicts how anatomical changes affect UA collapsibility. The gold standard objective measure of UA collapsibility is the pharyngeal critical pressure (Pcrit). A systematic literature review and meta-analysis were performed to identify the anatomical factors with the strongest correlation with Pcrit. A search using the PRISMA methodology was performed on PubMed for English language scientific papers that correlated Pcrit to anatomic variables and OSA severity as measured by the apnea-hypopnea index (AHI). A total of 29 papers that matched eligibility criteria were included in the quantitative synthesis. The meta-analysis suggested that AHI has only a moderate correlation with Pcrit (estimated Pearson correlation coefficient r = 0.46). The meta-analysis identified four key anatomical variables associated with UA collapsibility, namely hyoid position (r = 0.53), tongue volume (r = 0.51), pharyngeal length (r = 0.50), and waist circumference (r = 0.49). In the future, biomechanical models that quantify the relative importance of these anatomical factors in determining UA collapsibility may help identify the optimal intervention for each patient. Many anatomical and structural factors such as airspace cross-sectional areas, epiglottic collapse, and palatal prolapse have inadequate data and require further research.
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Affiliation(s)
- Phillip J Hartfield
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Joint Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jaroslaw Janczy
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Joint Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abhay Sharma
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hillary A Newsome
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rodney A Sparapani
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B Tucker Woodson
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Joint Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, USA.
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Aflah KA, Yohana W, Oscandar F. Volumetric measurement of the tongue and oral cavity with cone-beam computed tomography: A systematic review. Imaging Sci Dent 2022; 52:333-342. [PMID: 36605855 PMCID: PMC9807796 DOI: 10.5624/isd.20220067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose The goal of this systematic review was to compare the use of cone-beam computed tomography (CBCT) with that of computed tomography (CT) for volumetric evaluations of the tongue and oral cavity. Materials and Methods A search for articles was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. The PubMed, Scopus, ScienceDirect, and SAGE Journals databases were searched for articles published between 2011 and 2021. Articles were screened and assessed for eligibility. Screening involved checking for duplication, reading the title and abstract, and reading the full text. Results The initial search retrieved 25,780 articles. Application of the eligibility criteria yielded 16 articles for qualitative analysis. Multiple uses of CBCT were identified. In several studies, researchers assessed the volumetric correlation between tongue and oral cavity volumes, as well as other parameters. Post-treatment volumetric evaluations of the oral cavity were also reported, and the reliability of CBCT was assessed. The use of CT resembled that of CBCT. Conclusion CBCT has been used in the evaluation of tongue and oral cavity volumes to assess correlations between those volumes and with the upper airway. It has also been used for volumetric evaluation after surgical and non-surgical procedures and to assess the relationships between tongue volume, tooth position, occlusion, and body mass index. Participants with obstructive sleep apnea and malocclusion have been evaluated, and the reliability of CBCT has been assessed. In the included studies, CT was utilized for similar purposes as CBCT, but its reliability was not assessed.
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Affiliation(s)
| | - Winny Yohana
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Fahmi Oscandar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
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16
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Association Between Race and Opioid-Induced Respiratory Depression: An International Post Hoc Analysis of the Prediction of Opioid-induced Respiratory Depression In Patients Monitored by Capnography Trial. Anesth Analg 2022; 135:1097-1105. [PMID: 35350054 DOI: 10.1213/ane.0000000000006006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Opioid-induced respiratory depression (OIRD) is common on the medical and surgical wards and is associated with increased morbidity and health care costs. While previous studies have investigated risk factors for OIRD, the role of race remains unclear. We aim to investigate the association between race and OIRD occurrence on the medical/surgical ward. METHODS This is a post hoc analysis of the PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial; a prospective multinational observational blinded study of 1335 general ward patients who received parenteral opioids and underwent blinded capnography and oximetry monitoring to identify OIRD episodes. For this study, demographic and perioperative data, including race and comorbidities, were analyzed and assessed for potential associations with OIRD. Univariable χ 2 and Mann-Whitney U tests were used. Stepwise selection of all baseline and demographic characteristics was used in the multivariable logistic regression analysis. RESULTS A total of 1253 patients had sufficient racial data (317 Asian, 158 Black, 736 White, and 42 other races) for inclusion. The incidence of OIRD was 60% in Asians (N = 190/317), 25% in Blacks (N = 40/158), 43% in Whites (N = 316/736), and 45% (N = 19/42) in other races. Baseline characteristics varied significantly: Asians were older, more opioid naïve, and had higher opioid requirements, while Blacks had higher incidences of heart failure, obesity, and smoking. Stepwise multivariable logistic regression revealed that Asians had increased risk of OIRD compared to Blacks (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.54-4.04; P = .0002) and Whites (OR, 1.38; 95% CI, 1.01-1.87; P = .0432). Whites had a higher risk of OIRD compared to Blacks (OR, 1.81; 95% CI, 1.18-2.78; P = .0067). The model's area under the curve was 0.760 (95% CI, 0.733-0.787), with a Hosmer-Lemeshow goodness-of-fit test P value of .23. CONCLUSIONS This post hoc analysis of PRODIGY found a novel association between Asian race and increased OIRD incidence. Further study is required to elucidate its underlying mechanisms and develop targeted care pathways to reduce OIRD in susceptible populations.
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Zreaqat M, Hassan R, Samsudin R, Stas Y, Hanoun A. Three-dimensional analysis of upper airways in Class II malocclusion children with obstructive sleep apnea. J World Fed Orthod 2022; 11:156-163. [DOI: 10.1016/j.ejwf.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022]
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18
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Huang W, Wang X, Xu C, Xu H, Zhu H, Liu S, Zou J, Guan J, Yi H, Yin S. Prevalence, characteristics, and respiratory arousal threshold of positional obstructive sleep apnea in China: a large scale study from Shanghai Sleep Health Study cohort. Respir Res 2022; 23:240. [PMID: 36096792 PMCID: PMC9465879 DOI: 10.1186/s12931-022-02141-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the prevalence, characteristics, and respiratory arousal threshold (ArTH) of Chinese patients with positional obstructive sleep apnea (POSA) according to the Cartwright Classification (CC) and Amsterdam Positional Obstructive Sleep Apnea Classification (APOC). Methods A large-scale cross-sectional study was conducted in our sleep center from 2007 to 2018 to analyze the clinical and polysomnography (PSG) data of Chinese POSA patients. Low ArTH was defined based on PSG indices. Results Of 5,748 OSA patients, 36.80% met the CC criteria, and 42.88% the APOC criteria, for POSA. The prevalence of POSA was significantly higher in women than men (40.21% and 46.52% vs. 36.13% and 42.18% for CC and APOC, respectively). Chinese POSA patients had a lower apnea hypopnea index (AHI) and lower oxygen desaturation index, shorter duration of oxygen saturation (SaO2) < 90%, and a higher mean SaO2 and higher lowest SaO2 value compared to subjects with non-positional OSA (NPOSA). More than 40% of the POSA patients had a low ArTH; the proportion was extremely high in the supine-isolated-POSA (si-POSA) group and APOC I group. In multivariate logistic regression analyses, higher mean SaO2 and lower AHI during sleep were positive predictors of POSA. Conclusions According to the CC and APOC criteria, more than 1/3 of our Chinese subjects with OSA had POSA. Chinese POSA patients had less severe OSA and nocturnal hypoxia. Compared to NPOSA patients, significantly more patients with POSA had a low ArTH. A low ArTH may be an important endotype in the pathogenesis of POSA, especially in patients with si-POSA and APOC I. Further studies are necessary to develop personalized management strategies for POSA patients. Trial registration: Chinese Clinical Trial Registry; URL: http://www.chictr.org.cn; No. ChiCTR1900025714 (retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02141-3.
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19
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Altree TJ, Eckert DJ. Obstructive sleep apnea endotypes and their postoperative relevance. Int Anesthesiol Clin 2022; 60:1-7. [PMID: 35125480 DOI: 10.1097/aia.0000000000000357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas J Altree
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
- Respiratory and Sleep Services, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
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20
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Zhang XL, Zhang L, Li YM, Xiang BY, Han T, Wang Y, Wang C. Multidimensional assessment and cluster analysis for OSA phenotyping. J Clin Sleep Med 2022; 18:1779-1788. [PMID: 35338617 DOI: 10.5664/jcsm.9976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a heterogeneous disease with varying phenotype. A cluster analysis based on multidimensional disease characteristics, including symptom, anthropometry, polysomnography (PSG), and craniofacial morphology, in combination with auto-continuous positive airway pressure (CPAP) titration response and comorbidity profiles was performed within a well-characterized cohort of patients with OSA, with the aim to refine current phenotypic expressions of OSA with clinical implications. METHODS Two hundred and ninety-one subjects with a new diagnosis of moderate to severe OSA, referred for auto-CPAP titration to the sleep center were included for analysis. In-laboratory PSG and craniofacial computed tomography (CT) scanning was performed, followed by an auto-CPAP titration. The symptom of excessive daytime sleepiness (EDS) was assessed by Epworth sleepiness scale (ESS). RESULTS Three patient phenotypes, corresponding to the "normal weight, non-sleepy and moderate OSA", the "obese, non-sleepy and severe OSA" and "obese, sleepy, very severe OSA with craniofacial limitation" were identified. Among the PSG parameters, only N3% and mean pulse oxygen saturation (SPO2) were found to be associated with ESS, and they only explain small fraction of the variation (R2=0.136). Neck circumference and craniofacial limitation were associated the more severe phenotype, which had higher prevalence of hypertension, metabolic syndrome, greater diurnal blood gas abnormalities and worse PAP titration response. CONCLUSIONS Three OSA phenotypes were identified according to multiple aspect of clinical features in patients with moderate to severe OSA, which differed in prevalence of hypertension, metabolic syndrome, diurnal blood gas parameters and CPAP titration response. Self-reported EDS was not related with the severity of sleep breathing disturbance, and craniofacial limitation was associated the more severe phenotype. These findings highlight the necessity of integrate multiple disease characters into phenotyping to achieve better understanding of the clinical pictures of OSA.
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Affiliation(s)
- Xiao Lei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Peking University Health Science Center, Beijing, China.,Capital medical university, Beijing, China.,The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Peking University Health Science Center, Beijing, China
| | - Yi Ming Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Bo Yun Xiang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Teng Han
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yan Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Peking University Health Science Center, Beijing, China.,Capital medical university, Beijing, China.,The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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21
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Kazemeini E, Van de Perck E, Dieltjens M, Willemen M, Verbraecken J, Op de Beeck S, Vanderveken OM. Critical to Know Pcrit: A Review on Pharyngeal Critical Closing Pressure in Obstructive Sleep Apnea. Front Neurol 2022; 13:775709. [PMID: 35273554 PMCID: PMC8901991 DOI: 10.3389/fneur.2022.775709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
It is crucial to understand the underlying pathophysiology of obstructive sleep apnea (OSA). Upper airway collapsibility is an important pathophysiological factor that affects the upper airway in OSA. The aim of the current study was to review the existing body of knowledge on the pharyngeal collapsibility in OSA. After a thorough search through Medline, PubMed, Scopus, and Web of science, the relevant articles were found and used in this study. Critical closing pressure (Pcrit) is the gold standard measure for the degree of collapsibility of the pharyngeal airway. Various physiological factors and treatments affect upper airway collapsibility. Recently, it has been shown that the baseline value of Pcrit is helpful in the upfront selection of therapy options. The standard techniques to measure Pcrit are labor-intensive and time-consuming. Therefore, despite the importance of Pcrit, it is not routinely measured in clinical practice. New emerging surrogates, such as finite element (FE) modeling or the use of peak inspiratory flow measurements during a routine overnight polysomnography, may enable clinicians to have an estimate of the pharyngeal collapsibility. However, validation of these techniques is needed.
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Affiliation(s)
- Elahe Kazemeini
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Ear, Nose, Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Eli Van de Perck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Ear, Nose, Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Ear, Nose, Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium.,Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Ear, Nose, Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Ear, Nose, Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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22
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Ahmed AM, Zaky MN, El-Mekawy NM, Ollaek MA, Sami WM, Mohamed DM. Evaluation of thyromental height test in prediction of difficult airway in obese surgical patients: An observational study. Indian J Anaesth 2022; 65:880-885. [PMID: 35221360 PMCID: PMC8820326 DOI: 10.4103/ija.ija_675_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/20/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Thyromental height test (TMHT) has revealed good potentials for predicting difficult laryngoscopy view (DLV) in non-obese patients, but its accuracy in obese patients is not evident. This study aimed to assess the validity of TMHT as a predictor of DLV in obese surgical patients. METHODS 105 patients, aged 18-60 years, with body mass index (BMI) >30 kg/m2, scheduled for elective surgeries under general anaesthesia with an endotracheal tube inserted using conventional laryngoscope were included. Airway was assessed with TMHT, modified Mallampati test (MMT), neck circumference (NC) and NC/TMHT ratio. The DLV was defined as Cormack-Lehane grade ≥3. The primary endpoint was the validity of TMHT as a predictor of DLV. The secondary endpoints were to compare the accuracy of TMHT with that of the NC, MMT and NC/TMHT ratio as predictors of the difficult airway. RESULTS The BMI was 43.7 ± 6.6 kg/m2. The DLV cases were 23/105 (21.9%). The MMT, TMHT and NC/TMHT ratio had the best predictive ability of DLV with areas under receiver operating characteristic curve of 0.91, 0.92 and 0.80; at cut-off values >2, <47 mm and >7.9, respectively. MMT and TMHT were the only predictors of DLV by multivariate analysis. CONCLUSION In obese surgical patients, TMHT is an excellent predictor of DLV when the cut-off value is <47 mm.
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Affiliation(s)
- Abeer M Ahmed
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Monica N Zaky
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Nevan M El-Mekawy
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Mohamed A Ollaek
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Wael M Sami
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Dina M Mohamed
- Department of Anaesthesiology, Surgical ICU and Pain Management, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
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23
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Chen H, Elham E, Li Y, Ge S, Schmittbuhl M, Lavigne G, van der Stelt PF, Huynh N. Comparison of anatomic and aerodynamic characteristics of the upper airway among edentulous mild, moderate, and severe obstructive sleep apnea in older adults. J Clin Sleep Med 2022; 18:759-768. [PMID: 34636319 PMCID: PMC8883080 DOI: 10.5664/jcsm.9716] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES First, to compare the upper airway's anatomic and aerodynamic characteristics of the edentulous older adults who experience mild, moderate, and severe obstructive sleep apnea (OSA). Second, to examine the correlation between the severity of OSA and the anatomic and aerodynamic characteristic(s) of the upper airway in these edentulous individuals. METHODS NewTom5G cone beam computed tomography scans of 58 edentulous individuals with mild, moderate, and severe OSA were included in this analysis. 1) Computational models of the upper airway were reconstructed based on cone beam computed tomography images and the anatomical and aerodynamic characteristics of the upper airway were examined by an observer blind to OSA severity. 2) Pearson correlation analysis was used to determine the correlation between apnea-hypopnea index and the anatomic and aerodynamic characteristics of the upper airway. RESULTS Compared with edentulous patients with mild and moderate OSA, those with severe OSA have a more hourglass-shaped upper airway. The severity of OSA, namely, apnea-hypopnea index, was significantly correlated with the length, shape, and minimum cross-sectional area of the upper airway. During inspiration, the mean velocity of the airflow within the upper airway of the edentulous patients with severe OSA was higher than that of patients with mild and moderate OSA. During both inspiration and expiration, apnea-hypopnea index was found to be significantly correlated with maximum velocity (P = .05) and airway resistance (P = .024, 0.038). CONCLUSIONS The edentulous patients with severe OSA have a more hourglass-shaped upper airway. The findings also suggest that, during inspiration, the airflow travels faster in edentulous patients with severe OSA than in those with mild or moderate OSA. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The Effect of Nocturnal Wear of Dentures on Sleep and Oral Health Related Quality of Life; URL: https://clinicaltrials.gov/ct2/show/NCT01868295; Identifier: NCT01868295. CITATION Chen H, Elham E, Li Y, et al. Comparison of anatomic and aerodynamic characteristics of the upper airway among edentulous mild, moderate, and severe obstructive sleep apnea in older adults. J Clin Sleep Med. 2022;18(3):759-768.
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Affiliation(s)
- Hui Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong, China,Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada,Address correspondence to: Hui Chen, PhD, No. 44-1 Wenhua Road West, 250012, Jinan, Shandong, China; ; and Shaohua Ge, PhD, No. 44-1 Wenhua Road West, 250012, Jinan, Shandong, China;
| | - Emami Elham
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Yingguang Li
- Kunshan Industrial Technology Research Institute Co., Ltd., Kunshan, China
| | - Shaohua Ge
- Department of Periodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong, China,Address correspondence to: Hui Chen, PhD, No. 44-1 Wenhua Road West, 250012, Jinan, Shandong, China; ; and Shaohua Ge, PhD, No. 44-1 Wenhua Road West, 250012, Jinan, Shandong, China;
| | | | - Gilles Lavigne
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | | | - Nelly Huynh
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
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24
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Li WY, Masse JF, Gakwaya S, Zhao Z, Wang W, Sériès F. Differences in Predicted Therapeutic Outcome of Mandibular Advancement Determined by Remotely Controlled Mandibular Positioner in Canadian and Chinese Apneic Patients. Nat Sci Sleep 2022; 14:1611-1622. [PMID: 36105925 PMCID: PMC9467296 DOI: 10.2147/nss.s377758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In-lab mandibular protrusive titration using a remotely controlled mandibular positioner (RCMP) could predict the success rate of mandibular advancement device (MAD) and reliably determine the Optimal Protrusive Position (OPP) for obstructive sleep apnea (OSA) patients. The aim of this study was to compare MAD success rate using in-lab RCMP manual titration performed in Caucasian and Chinese OSA patients. METHODS Manual RCMP titration was performed during an in-lab sleep study using the same procedure that had been previously reported in untreated Caucasian and Chinese OSA patients. Success rate was determined according to classical success criteria or to those previously used for RCMP titration. RESULTS A total of 160 subjects were included in this study, and conclusive data were obtained from 141 (71 Chinese and 70 Caucasian OSA patients). Chinese patients were significantly younger, with lower BMI and more severe OSA disease than the Canadian counterparts. Among patients with predicted success, the OPP expressed in % of full protrusion position did not differ between the two ethnic groups. Chinese ethnicity, younger age and lower baseline AHI were significant determinants of RCMP success. In a multivariate analysis, only ethnicity and AHI were found to significantly account for success, the odds ratio for success in Chinese compared to Caucasians corrected for AHI being 3.7 and 4.6 depending on criteria used to define success. CONCLUSION Although the OSA disease was more severe in Chinese patients, the predicted success rate of MAD according to RCMP titration was higher in Chinese than in Caucasians. This study was registered on ClinicalTrials.gov (NCT03231254).
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Affiliation(s)
- Wen-Yang Li
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | | | - Simon Gakwaya
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Zhenjin Zhao
- Institute of Orthodontics, The Stomatological Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wei Wang
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Frédéric Sériès
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
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25
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Differentiation Model for Insomnia Disorder and the Respiratory Arousal Threshold Phenotype in Obstructive Sleep Apnea in the Taiwanese Population Based on Oximetry and Anthropometric Features. Diagnostics (Basel) 2021; 12:diagnostics12010050. [PMID: 35054218 PMCID: PMC8774350 DOI: 10.3390/diagnostics12010050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 01/16/2023] Open
Abstract
Insomnia disorder (ID) and obstructive sleep apnea (OSA) with respiratory arousal threshold (ArTH) phenotypes often coexist in patients, presenting similar symptoms. However, the typical diagnosis examinations (in-laboratory polysomnography (lab-PSG) and other alternatives methods may therefore have limited differentiation capacities. Hence, this study established novel models to assist in the classification of ID and low- and high-ArTH OSA. Participants reporting insomnia as their chief complaint were enrolled. Their sleep parameters and body profile were accessed from the lab-PSG database. Based on the definition of low-ArTH OSA and ID, patients were divided into three groups, namely, the ID, low- and high-ArTH OSA groups. Various machine learning approaches, including logistic regression, k-nearest neighbors, naive Bayes, random forest (RF), and support vector machine, were trained using two types of features (Oximetry model, trained with oximetry parameters only; Combined model, trained with oximetry and anthropometric parameters). In the training stage, RF presented the highest cross-validation accuracy in both models compared with the other approaches. In the testing stage, the RF accuracy was 77.53% and 80.06% for the oximetry and combined models, respectively. The established models can be used to differentiate ID, low- and high-ArTH OSA in the population of Taiwan and those with similar craniofacial features.
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26
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Ng SS, Tam WW, Lee RW, Chan TO, Yiu K, Yuen BT, Wong KT, Woo J, Ma RC, Chan KK, Ko FW, Cistulli PA, Hui DS. Effect of Weight Loss and CPAP on OSA and Metabolic Profile Stratified by Craniofacial Phenotype: A Randomized Clinical Trial. Am J Respir Crit Care Med 2021; 205:711-720. [PMID: 34936531 DOI: 10.1164/rccm.202106-1401oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Craniofacial structure is thought to modulate the effect of weight loss on OSA, but whether this affects metabolic profile after weight loss compared with continuous positive airway pressure(CPAP) is unknown among obese Chinese patients with obstructive sleep apnea(OSA). OBJECTIVES To compare the change in metabolic profile between lifestyle modification program(LMP), stratified by craniofacial phenotype, and CPAP therapy for 6 months. METHODS We randomly assigned 194 patients with BMI≥25kg/m2 and moderate-to-severe OSA to receive LMP or CPAP therapy for 6 months in a 2:1 ratio. Assessments included computed tomography for assessing maxillomandibular volume(MMV), high sensitivity C-reactive protein(hsCRP) and insulin sensitivity. Measurements and Main Results(mean±SD or median[interquartile range]): Among 128 and 66 subjects in LMP group and CPAP group, respectively, hsCRP reduced more in LMP group than the CPAP group (-0.7[-1.4 to -0.0]mg/L vs -0.3[-0.9 to 0.4]mg/L, p=0.012). More patients in LMP group achieved low hsCRP(<1mg/L) than the CPAP group(21.1% vs 9.1%, p=0.04). Insulin sensitivity improved only in LMP group with 3.1(95%CI 1.5-6.6) times more patients with normal glucose regulation after intervention. LMP group was stratified into LMP-small MMV(n=64) and LMP-large MMV(n=64) groups according to the median MMV value of 233.2cm3. There was no significant difference in hsCRP(-0.7[-1.3 to 0.1] vs -0.7[-1.5 to -0.2], p=0.884) and insulin sensitivity(0.5[-0.2 to 1.9] vs 0.6[0.1 to 2.0], p=0.4860) between LMP-small and LMP-large MMV groups. CONCLUSION Weight reduction improved subclinical inflammation and insulin sensitivity more than CPAP among obese Chinese patients with moderate to severe OSA, and this effect was not influenced by craniofacial structure. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT03287973.
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Affiliation(s)
- Susanna Ss Ng
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Wilson Ws Tam
- National University of Singapore, 37580, Alice Lee Centre for Nursing Studies, Singapore, Singapore
| | - Richard Ww Lee
- Gosford Hospital, 90112, Department of Respiratory and Sleep Medicine, Gosford, New South Wales, Australia
| | - Tat-On Chan
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Karen Yiu
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Brian Ty Yuen
- Prince of Wales Hospital, 13621, Department of Imaging & Interventional Radiology, Hong Kong, Hong Kong
| | - Ka-Tak Wong
- Prince of Wales Hospital, 13621, Department of Imaging & Interventional Radiology, Hong Kong, Hong Kong
| | - Jean Woo
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Ronald Cw Ma
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong.,The Chinese University of Hong Kong Hong Kong Institute of Diabetes and Obesity, 596882, Hong Kong, Hong Kong
| | - Ken Kp Chan
- The Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine and Therapeutics, Hong Kong, Hong Kong
| | - Fanny Ws Ko
- The Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine and Therapeutics, Hong Kong, Hong Kong
| | - Peter A Cistulli
- The University of Sydney Faculty of Medicine and Health, 522555, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - David S Hui
- The Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong;
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Zhang L, Zhang X, Li YM, Xiang BY, Han T, Wang Y, Wang C. Association of Craniofacial and Upper Airway Morphology with Cardiovascular Risk in Adults with OSA. Nat Sci Sleep 2021; 13:1689-1700. [PMID: 34629918 PMCID: PMC8493274 DOI: 10.2147/nss.s332117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Clinical and population-based studies have demonstrated a strong association between obstructive sleep apnea (OSA) and cardiovascular disease (CVD). Anatomical abnormalities of the craniofacial region and upper airway are important risk factors for OSA. The objective of this study was to investigate the association of craniofacial and upper airway morphology with CVD risk biomarkers. METHODS One hundred and sixty-nine male patients with OSA underwent in-laboratory polysomnography (PSG) and upper airway computed tomography (CT) scanning. Ten-year Framingham CVD risk score (FRS) was calculated and categorized into low- and moderate-to-high-risk groups. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured as a biomarker of increased myocardial wall stress. RESULTS Compared to the low-risk group, total sleep time (TST), the proportion of N3 (N3%) and mean oxygen saturation (SpO2mean) were lower, while the arousal index of non-rapid eye movement (NREM) sleep, apnea index (AI) of NREM sleep, apnea hypopnea index (AHI) of NREM sleep, oxygen desaturation index (ODI) and percentage of total sleep time spent with oxyhemoglobin saturation below 90% (TST90) were higher in the moderate-to-high risk group. The corrected upper airway length (UAL), ANB angle and gonion-gnathion-hyoid angle were larger for subjects in the moderate-to-high risk group than those in the low-risk group. In multiple regression analysis, TST, AINREM and adjusted UAL were independently associated with moderate-to-high CVD risk. Plasma NT-proBNP levels were higher in patients in the moderate- to high-risk group, and among the PSG and CT scan parameters, only SPO2mean was marginally associated with NT-proBNP (r=0.183, P=0.054). CONCLUSION Craniofacial and upper airway features may contain valid cues about CVD risk, and sleep duration, obstructive event type and occurrence phase may be closely related to CVD risk for patients with OSA.
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Affiliation(s)
- Li Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
| | - Xiaolei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
- Capital Medical University, Beijing, People's Republic of China
- The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yi Ming Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Bo Yun Xiang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Teng Han
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Yan Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
- Peking University Health Science Center, Beijing, People's Republic of China
- Capital Medical University, Beijing, People's Republic of China
- The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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Zhang L, Yan YR, Li SQ, Li HP, Lin YN, Li N, Sun XW, Ding YJ, Li CX, Li QY. Moderate to severe OSA screening based on support vector machine of the Chinese population faciocervical measurements dataset: a cross-sectional study. BMJ Open 2021; 11:e048482. [PMID: 34535476 PMCID: PMC8451311 DOI: 10.1136/bmjopen-2020-048482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Obstructive sleep apnoea (OSA) has received much attention as a risk factor for perioperative complications and 68.5% of OSA patients remain undiagnosed before surgery. Faciocervical characteristics may screen OSA for Asians due to smaller upper airways compared with Caucasians. Thus, our study aimed to explore a machine-learning model to screen moderate to severe OSA based on faciocervical and anthropometric measurements. DESIGN A cross-sectional study. SETTING Data were collected from the Shanghai Jiao Tong University School of Medicine affiliated Ruijin Hospital between February 2019 and August 2020. PARTICIPANTS A total of 481 Chinese participants were included in the study. PRIMARY AND SECONDARY OUTCOME: (1) Identification of moderate to severe OSA with apnoea-hypopnoea index 15 events/hour and (2) Verification of the machine-learning model. RESULTS Sex-Age-Body mass index (BMI)-maximum Interincisal distance-ratio of Height to thyrosternum distance-neck Circumference-waist Circumference (SABIHC2) model was set up. The SABIHC2 model could screen moderate to severe OSA with an area under the curve (AUC)=0.832, the sensitivity of 0.916 and specificity of 0.749, and performed better than the STOP-BANG (snoring, tiredness, observed apnea, high blood pressure, BMI, age, neck circumference, and male gender) questionnaire, which showed AUC=0.631, the sensitivity of 0.487 and specificity of 0.772. Especially for asymptomatic patients (Epworth Sleepiness Scale <10), the SABIHC2 model demonstrated better predictive ability compared with the STOP-BANG questionnaire, with AUC (0.824 vs 0.530), sensitivity (0.892 vs 0.348) and specificity (0.755 vs 0.809). CONCLUSION The SABIHC2 machine-learning model provides a simple and accurate assessment of moderate to severe OSA in the Chinese population, especially for those without significant daytime sleepiness.
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Affiliation(s)
- Liu Zhang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya Ru Yan
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi Qi Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Peng Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Ni Lin
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xian Wen Sun
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Jie Ding
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuan Xiang Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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29
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Thuler E, Rabelo FAW. Correlation between the transverse dimension of maxilla and OSA. J Clin Sleep Med 2021; 17:2571. [PMID: 34398742 DOI: 10.5664/jcsm.9608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Eric Thuler
- Sleep Surgery Division, ORL-HNS Department, University of Pennsylvania, Philadelphia, Pennsylvania
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30
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Seet E, Chung F, Wang CY, Tam S, Kumar CM, Ubeynarayana CU, Yim CC, Chew EFF, Lam CKM, Cheng BCP, Chan MTV. Association of Obstructive Sleep Apnea With Difficult Intubation: Prospective Multicenter Observational Cohort Study. Anesth Analg 2021; 133:196-204. [PMID: 33720906 DOI: 10.1213/ane.0000000000005479] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has been found to be associated with difficult airway, although there is a paucity of prospective studies investigating thresholds of OSA severity with difficult airway outcomes. The aim of this study was to examine the association between OSA and difficult intubation or difficult mask ventilation. We also explored the utility of the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender (STOP-Bang) score for difficult airway prediction. METHODS The Postoperative Vascular Complications in Unrecognized Obstructive Sleep Apnea (POSA) trial was an international prospective cohort study of surgical patients 45 years or older with one or more cardiac risk factor presenting for noncardiac surgery, with planned secondary analyses of difficult airway outcomes. Multivariable logistic regression analyses tested associations between OSA severity and predictors of difficult airway with difficult intubation or difficult mask ventilation. Overall, 869 patients without prior diagnosis of OSA were screened for OSA risk with the STOP-Bang tool, underwent preoperative sleep study, and had routine perioperative care, including general anesthesia with tracheal intubation. The primary outcome analyzed was difficult intubation, and the secondary outcome was difficult mask ventilation. RESULTS Based on the sleep studies, 287 (33%), 324 (37%), 169 (20%), and 89 (10%) of the 869 patients had no, mild, moderate, and severe OSA, respectively. One hundred and seventy-two (20%) had a STOP-Bang score of 0-2 (low risk), 483 (55%) had a STOP-Bang score of 3-4 (intermediate risk), and 214 (25%) had a STOP-Bang score 5-8 (high risk). The incidence of difficult intubation was 6.7% (58 of 869), and difficult mask ventilation was 3.7% (32 of 869). Multivariable logistic regression demonstrated that moderate OSA (odds ratio [OR] = 3.26 [95% confidence interval {CI}, 1.37-8.38], adjusted P = .010) and severe OSA (OR = 4.05 [95% CI, 1.51-11.36], adjusted P = .006) but not mild OSA were independently associated with difficult intubation compared to patients without OSA. Relative to scores of 0-2, STOP-Bang scores of 3-4 and 5-8 were associated with increased odds of difficult intubation (OR = 3.01 [95% CI, 1.13-10.40, adjusted P = .046] and 4.38 [95% CI, 1.46-16.36, adjusted P = .014]), respectively. OSA was not associated with difficult mask ventilation, and only increasing neck circumference was found to be associated (adjusted P = .002). CONCLUSIONS Moderate and severe OSA were associated with difficult intubation, and increasing neck circumference was associated with difficult mask ventilation. A higher STOP-Bang score of 3 or more may be associated with difficult intubation versus STOP-Bang score of 0-2. Anesthesiologists should be vigilant for difficult intubation when managing patients suspected or diagnosed with OSA.
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Affiliation(s)
- Edwin Seet
- From the Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Anaesthesia, Khoo Teck Puat Hospital, National Healthcare Group, Singapore
| | - Frances Chung
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Chew Yin Wang
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Stanley Tam
- Department of Anesthesia, Scarborough Health Network, Scarborough, Ontario, Canada
| | - Chandra M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, National Healthcare Group, Singapore
| | | | - Carolyn C Yim
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Eleanor F F Chew
- Department of Anesthesiology and Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Carmen K M Lam
- Department of Anaesthesia, Tuen Mun Hospital, Hong Kong Special Administrative Region, China
| | - Benny C P Cheng
- Department of Anaesthesia, Tuen Mun Hospital, Hong Kong Special Administrative Region, China
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Truong L, Reher P, Doan N. Correlation between upper airway dimension and TMJ position in patients with sleep disordered breathing. Cranio 2020:1-9. [DOI: 10.1080/08869634.2020.1853465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Laura Truong
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - Peter Reher
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - Nghiem Doan
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
- Private Practice, Brisbane, Australia
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The short evaluation of orofacial myofunctional protocol (ShOM) and the sleep clinical record in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 137:110240. [PMID: 32896353 DOI: 10.1016/j.ijporl.2020.110240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/31/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Multiple anatomic and functional risk factors contribute to Obstructive Sleep Apnea (OSA) in children, most of the screening tools only evaluate clinical symptoms. The aim was to describe the evaluation of the short orofacial myofunctional protocol (ShOM) in OSA children, and to analyze if the inclusion of orofacial myofunctional aspects would influence the screening sensitivity/specificity of the Sleep Clinical Record (SCR). METHODS Children from Brazil and Italy with sleep disordered breathing were evaluated by full night polygraphy, the SCR and the ShOM. For the analysis of the correlations, we normalized the distribution of the children based on the percentiles of the Apnea and Hypopnea Index (AHI). The children were divided in: Group1: first percentile AHI up to25% (cut-off value: AHI≤1.9); Group 2: second percentile from 25% to 75% (cut-off values: 1.9˂AHI≤7.9); Group3: third percentile AHI˃75% (cut = off value: AHI˃7.9). The findings of SCR and ShOM were compared for each group. ROC curve of the sensitivity and specificity of OSA diagnosis were compared for SCR alone and the combined results of SCR plus ShOM. RESULTS 86 children, 47 girls, 4-11 years, were included, 34 children were obese and 20 overweight. OSA severity and obesity showed a positive correlation (p = 0.04). Mean ShOM score was 5.64 ± 2.27, with a positive correlation to the SCR (p = 0.002). In Group1, the SCR showed more nasal obstruction, arched palate and OSAS score/positive Brouilette questionnaire and the ShOM scored more alterations to breathing mode, breathing type (p = 0.01) and lip competence. In Group 3, we found more tonsillar hypertrophy, Friedman tongue position alteration (p < 0.001), malocclusion and obesity at SCR and more alterations in tongue resting position, tongue deglutition position and malocclusion at ShOM. CONCLUSIONS The myofuntional evaluation contributed to the screening of OSA in children, while alterations of the tongue (resting and deglutition position) were observed in children with the highest AHI percentile. The combination of SCR and ShOM improved the sensitivity and specificity for the identification of pediatric OSA when compared to SCR alone.
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Lyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology 2020; 25:690-702. [PMID: 32436658 DOI: 10.1111/resp.13838] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/01/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
One-seventh of the world's adult population, or approximately one billion people, are estimated to have OSA. Over the past four decades, obesity, the main risk factor for OSA, has risen in striking proportion worldwide. In the past 5 years, the WHO estimates global obesity to affect almost two billion adults. A second major risk factor for OSA is advanced age. As the prevalence of the ageing population and obesity increases, the vulnerability towards having OSA increases. In addition to these traditional OSA risk factors, studies of the global population reveal select contributing features and phenotypes, including extreme phenotypes and symptom clusters that deserve further examination. Untreated OSA is associated with significant comorbidities and mortality. These represent a tremendous threat to the individual and global health. Beyond the personal toll, the economic costs of OSA are far-reaching, affecting the individual, family and society directly and indirectly, in terms of productivity and public safety. A better understanding of the pathophysiology, individual and ethnic similarities and differences is needed to better facilitate management of this chronic disease. In some countries, measures of the OSA disease burden are sparse. As the global burden of OSA and its associated comorbidities are projected to further increase, the infrastructure to diagnose and manage OSA will need to adapt. The use of novel approaches (electronic health records and artificial intelligence) to stratify risk, diagnose and affect treatment are necessary. Together, a unified multi-disciplinary, multi-organizational, global approach will be needed to manage this disease.
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Affiliation(s)
- M Melanie Lyons
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Nitin Y Bhatt
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Upper airway morphological changes in obstructive sleep apnoea: effect of age on pharyngeal anatomy. The Journal of Laryngology & Otology 2020; 134:354-361. [PMID: 32284084 DOI: 10.1017/s0022215120000766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea. METHODS A 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. RESULTS Soft 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. CONCLUSION A 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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Ribeiro ADA, Smith FJ, Nary Filho H, Trindade IEK, Tonello C, Trindade-Suedam IK. Three-Dimensional Upper Airway Assessment in Treacher Collins Syndrome. Cleft Palate Craniofac J 2019; 57:371-377. [DOI: 10.1177/1055665619885555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: The purpose of this investigation was to assess the pharyngeal dimensions and the craniofacial morphology of individuals with Treacher Collins syndrome (TCS) when compared to vertical skeletal class II individuals. It is our hypothesis that the upper airways of individuals with TCS are reduced in view of the skeletal pattern and the maxillomandibular dysmorphologies. Materials and Methods: Cone-beam computed tomography scans of 26 individuals had the pharyngeal volume (V) and minimal cross-sectional area (mCSA) evaluated. Study group (TCS) was formed by 13 scans of patients with TCS (7 males and 6 females; 20.2 ± 4.7 years). Control group (CG) assembled 13 scans of nonaffected individuals with the same type of skeletal pattern (2 males and 11 females; 26.6 ± 5.4 years). Cephalometric data of maxillomandibular position, maxillomandibular dimensions, and growth pattern were assessed. Statistical analysis ( P ≤ .05) included Student t test and Pearson correlation coefficient. Results: Although reduced, pharyngeal V and mCSA of TCS were not statistically different from the CG. On both groups, mCSA was mostly at the oropharyngeal level. Individuals with TCS presented retrognathic chin, reduced maxillomandibular dimensions, and increased clockwise rotation of the palatal plane. Maxillary and mandibular lengths were correlated with pharyngeal V and mCSA. Conclusions: The pharyngeal dimensions of individuals with TCS are impacted by the micrognathia and retrognathia. In association with the skeletal pattern, the reduction of the airways, although not statistically significant, may explain the increased prevalence of airways disorder in this syndrome.
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Affiliation(s)
- Alexandre de Almeida Ribeiro
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Brazil
| | - Francis Joel Smith
- Anschutz Medical Campus Bookstore, University of Colorado at Denver, CO, USA
| | | | - Inge E. K. Trindade
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Brazil
| | - Cristiano Tonello
- School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Brazil
| | - Ivy K. Trindade-Suedam
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Brazil
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Chen HC, Wang CJ, Lo YL, Hsu HC, Huang CG, Kuo IC, Lu YA, Hsin LJ, Lin WN, Fang TJ, Li HY, Lee LA. Parapharyngeal fat pad area at the subglosso-supraglottic level is associated with corresponding lateral wall collapse and apnea-hypopnea index in patients with obstructive sleep apnea: a pilot study. Sci Rep 2019; 9:17722. [PMID: 31776365 PMCID: PMC6881471 DOI: 10.1038/s41598-019-53515-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/01/2019] [Indexed: 01/26/2023] Open
Abstract
The aim of this study was to assess associations between fat pad areas at various anatomic levels and the sites of lateral wall collapse and disease severity in adult patients with obstructive sleep apnea (OSA). Forty-one patients with OSA who prospectively underwent drug-induced sleep computed tomography were included. Areas of parapharyngeal fat pads and degrees of lateral wall collapse at three representative anatomic levels (nasopharynx, oropharynx, and subglosso-supraglottis), and apnea-hypopnea index (AHI) were measured. In the subglosso-supraglottic region, the parapharyngeal fat pad area in 17 (41%) patients with complete lateral wall collapse was significantly larger than that in 24 (59%) patients without complete collapse (median, 236.0 mm2 vs 153.0 mm2; P = 0.02). In multivariate regression analysis, the parapharyngeal fat pad area at the subglosso-supraglottic level (β = 0.02; P = 0.01) and body mass index (β = 3.24; P = 0.01) were independently associated with AHI. Our preliminary results supported that parapharyngeal fat pads at the subglosso-supraglottic level may be involved in the development of lateral wall collapse and then determine the severity of OSA. Further studies are warranted to investigate the effect of reducing parapharyngeal fat pads in the treatment of OSA.
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Affiliation(s)
- Hung-Chin Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Chao-Jan Wang
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC.,Department of Medical Imaging and Intervention, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC
| | - Yu-Lun Lo
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC.,Department of Thoracic Medicine, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC
| | - Hao-Chun Hsu
- Department of Bio-Industrial Mechatronics Engineering, National Taiwan University, Taipei, 10617, Taiwan, ROC
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - I-Chun Kuo
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Yi-An Lu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Li-Jen Hsin
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Wan-Ni Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC
| | - Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan, ROC. .,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, ROC.
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Abstract
The prevalence of obstructive sleep apnea (OSA) is considered to be very high in western industrialized countries. There are conservative and surgical forms of treatment for OSA; however, the pathophysiology is largely unexplained and cannot be explained by anatomical abnormalities alone. In recent years, a number of non-anatomical factors have been found that favor the development of OSA. These include the respiratory excitation threshold (arousals), the respiratory drive (loop gain), as well as the control and function of the muscular upper airway dilators. The understanding of the individual pathophysiological processes may be helpful in the future to develop individual treatment approaches for patients.
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O’Driscoll DM, Landry SA, Pham J, Young A, Sands SA, Hamilton GS, Edwards BA. The physiological phenotype of obstructive sleep apnea differs between Caucasian and Chinese patients. Sleep 2019; 42:5550355. [DOI: 10.1093/sleep/zsz186] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/08/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
Study Objectives
The mechanisms responsible for the development of obstructive sleep apnea (phenotypic “traits”) are known to differ between individuals and may differ across ethnicities. We aimed to examine whether loop gain, arousal threshold, pharyngeal collapsibility and muscle compensation differ between Chinese and Caucasian individuals with OSA.
Methods
We noninvasively determined the relative contribution of loop gain, arousal threshold, pharyngeal collapsibility, and muscle compensation from the ventilatory flow pattern recorded during a standard clinical polysomnography in a cohort of age and AHI matched Caucasian and Chinese patients with moderate-severe OSA (n = 90).
Results
Chinese participants had significantly more collapsible pharyngeal airways as indicated by a lower Vpassive (68.9 [51.5–75.2] vs. 74.0 [65.1–80.4] %Veupnea, U = 703, p = 0.012), but less ventilatory control instability as indicated by a lower loop gain (0.60 [0.50–0.67] vs. 0.63 [0.57–0.81], U = 762, p = 0.043) compared with Caucasian participants. Further, multiple logistic regression analyses demonstrated that the combined pharyngeal collapsibility (Vpassive) and loop gain traits help to better explain the differences between the groups beyond upper-airway collapsibility alone. No statistically significant group differences were found in muscle compensation or arousal threshold traits between groups.
Conclusion
Individuals of Chinese descent appear to have OSA that is driven much more by the relative contribution of their anatomical predisposition and to a lesser extent nonanatomical causes compared with Caucasians. Future research should focus on determining if Chinese versus Caucasian ethnicity is an important contributing factor to clinical outcomes and therapeutic responses in OSA.
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Affiliation(s)
- Denise M O’Driscoll
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Shane A Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Jonathan Pham
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Australia
| | - Alan Young
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Garun S Hamilton
- School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Lung and Sleep, Monash Health, Melbourne, Australia
- Monash Partners—Epworth, Melbourne, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
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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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Eguchi K, Chan JYK, Tateya I, Shimizu A, Holsinger FC, Sugimoto T. Curved Laryngopharyngoscope With Flexible Next-Generation Robotic Surgical System for Transoral Hypopharyngeal Surgery: A Preclinical Evaluation. Ann Otol Rhinol Laryngol 2019; 128:1023-1029. [DOI: 10.1177/0003489419856391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The indication of transoral robotic surgery for hypopharyngeal cancer is limited because of poor accessibility. The aim of this study was to explore the efficacy of a curved laryngopharyngoscope used in combination with a next-generation flexible robotic surgical system for accessing and resecting the hypopharynx. Methods: A comparative evaluation of the curved laryngopharyngoscope versus standard straight-blade retractors using the flexible robotic surgical system was conducted on 2 cadavers. End points measured included visualization, accessibility, and ease of dissection for accessing and resecting the hypopharynx. Results: Visualization, accessibility, and dissection were superior with the curved laryngopharyngoscope in all subareas of the hypopharynx. The advantages of accessibility and visualization were much more evident in the cadaver with a high body mass index. Conclusions: These preclinical data suggest that using a curved laryngopharyngoscope in combination with a flexible robotic surgical system may lead to technical innovations concerning transoral surgery of the hypopharynx.
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Affiliation(s)
- Kohtaro Eguchi
- Department of Otolaryngology–Head and Neck Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Jason Y. K. Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ichiro Tateya
- Department of Otolaryngology–Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Shimizu
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - F. Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Stanford, CA, USA
| | - Taro Sugimoto
- Department of Otolaryngology–Head and Neck Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
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Corrêa CDC, Kayamori F, Weber SAT, Bianchini EMG. Scientific production of Brazilian speech language pathologists in sleep medicine. ACTA ACUST UNITED AC 2018; 11:183-210. [PMID: 30455851 PMCID: PMC6201521 DOI: 10.5935/1984-0063.20180033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Previous diagnosis and intervention in patients with sleep-disordered
breathing involves several health professionals. Speech-Language and Hearing
Sciences (SLHS) performance has been solidified through scientific
production. Objective: To describe the inclusion of Brazilian Speech-Language Pathologists (SLP) in
the field of sleep disorders, through the description of studies, scientific
publications and participation in scientific events. Data Synthesis: A search and an analysis of the Brazilian SLP publications in the field of
sleep disorders were carried out, including articles, monographs,
dissertations, thesis and abstracts published in annals of events. The
databases Lilacs, SciELO, Pubmed, Google Scholar tool and Lattes platform
were accessed, with final search in January 2018. The analysis consisted of
a description of the year of publication, type of publication, area of the
SLHS, place of publication and/or event. 40 articles were found in national
and international journals, from 1999 to 2017. In relation to publications
in books, one book about the subject was published in 2009 and eight
chapters of books were published. In the monograph format, 21 studies were
carried out, there are 13 dissertations and eight thesis. A total of 151
abstracts were published in annals of scientific events, from 2001 to 2017
and 63 lectures were conducted by SLP. Conclusion: The inclusion of Brazilian SLP in the area of sleep disorders has been
supported by scientific publications in the format of articles in national
and international journals, monographs, thesis, dissertations, books and
publications in event annals.
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Affiliation(s)
- Camila de Castro Corrêa
- Botucatu Medical School, UNESP, Department of Ophtalmology, Otolaryngology and Head and Neck Surgery - Botucatu - São Paulo - Brazil
| | - Fabiane Kayamori
- Pontifícia Universidade Católica, Department of Speech-Language Pathology - São Paulo - São Paulo - Brazil
| | - Silke Anna Theresa Weber
- Botucatu Medical School, UNESP, Department of Ophtalmology, Otolaryngology and Head and Neck Surgery - Botucatu - São Paulo - Brazil
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Hnin K, Mukherjee S, Antic NA, Catcheside P, Chai-Coetzer CL, McEvoy D, Vakulin A. The impact of ethnicity on the prevalence and severity of obstructive sleep apnea. Sleep Med Rev 2018; 41:78-86. [PMID: 30149931 DOI: 10.1016/j.smrv.2018.01.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 01/06/2018] [Accepted: 01/11/2018] [Indexed: 12/31/2022]
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Phenotypic approaches to obstructive sleep apnoea – New pathways for targeted therapy. Sleep Med Rev 2018; 37:45-59. [DOI: 10.1016/j.smrv.2016.12.003] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 02/01/2023]
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Abstract
The prevalence of obstructive sleep apnea (OSA) continues to rise. So too do the health, safety, and economic consequences. On an individual level, the causes and consequences of OSA can vary substantially between patients. In recent years, four key contributors to OSA pathogenesis or "phenotypes" have been characterized. These include a narrow, crowded, or collapsible upper airway "anatomical compromise" and "non-anatomical" contributors such as ineffective pharyngeal dilator muscle function during sleep, a low threshold for arousal to airway narrowing during sleep, and unstable control of breathing (high loop gain). Each of these phenotypes is a target for therapy. This review summarizes the latest knowledge on the different contributors to OSA with a focus on measurement techniques including emerging clinical tools designed to facilitate translation of new cause-driven targeted approaches to treat OSA. The potential for some of the specific pathophysiological causes of OSA to drive some of the key symptoms and consequences of OSA is also highlighted.
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Affiliation(s)
- Amal M Osman
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Sophie G Carter
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA).,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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Balakrishnan KP, Chockalingam PA. Ethnicity and upper airway measurements: A study in South Indian population. Indian J Anaesth 2017; 61:622-628. [PMID: 28890556 PMCID: PMC5579851 DOI: 10.4103/ija.ija_247_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Most studies on upper airway are conducted based on airway measurements in the western population. We set out to find the normal values of upper airway measurements in South Indian population. The aim of this study was to perform various upper airway examinations and to set standards for normal measurements in the South Indian population as well as to analyse the data for predictors of difficult intubation. Methods: This prospective observational study was conducted in a tertiary cancer hospital in Southern India. Airway assessment parameters, including modified Mallampati classification (MPC), upper lip bite test (ULBT), sternomental distance, thyromental distance (TMD), and the inter-incisor distance were documented for 2004 patients meeting the inclusion criteria. Laryngoscopic view after induction was graded as per Cormack and Lehane's (CL) classification. Any CL ≥3 was considered to be difficult laryngoscopy. The collected data (2004 cases) was analyed with SPSS software version 17. Receiver operating characteristics (ROC) curve was used to determine cut-offs in the population. Sensitivity, specificity, positive and negative predictive value were computed. Results: MPC, ULBT, and ratio of height to TMD (RHTMD) predicted difficult intubation with sensitivity of 40.86%, 45.53% and 64.60%, respectively and these were statistically significant with P < 0.001. Using the area under the curve of the ROC curve and discrimination analysis normal RHTMD in our population had a cut off value of 17.1. Conclusion: The cut off value for RHTMD to predict difficult laryngoscopy in the South Indian population is 17.1.
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Godoy IRB, Martinez-Salazar EL, Eajazi A, Genta PR, Bredella MA, Torriani M. Fat accumulation in the tongue is associated with male gender, abnormal upper airway patency and whole-body adiposity. Metabolism 2016; 65:1657-1663. [PMID: 27733254 PMCID: PMC5367267 DOI: 10.1016/j.metabol.2016.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/31/2016] [Accepted: 08/28/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine associations between tongue adiposity with upper airway measures, whole-body adiposity and gender. We hypothesized that increased tongue adiposity is higher in males and positively associated with abnormal upper airway measures and whole-body adiposity. METHODS We studied subjects who underwent whole-body positron emission tomography/computed tomography to obtain tongue attenuation (TA) values and cross-sectional area, pharyngeal length (PL) and mandibular plane to hyoid distance (MPH), as well as abdominal circumference, abdominal subcutaneous and visceral (VAT) adipose tissue areas, neck circumference (NC) and neck adipose tissue area. Metabolic syndrome was determined from available clinical and laboratory data. RESULTS We identified 206 patients (104 females, 102 males) with mean age 56±17years and mean body mass index (BMI) 28±6kg/m2 (range 16-47kg/m2). Males had lower TA values (P=0.0002) and higher upper airway measures (P<0.0001) independent of age and BMI (P<0.001). In all subjects, TA was negatively associated with upper airway measures (P<0.001). TA was negatively associated with body composition parameters (all P<0.0001), most notably with VAT (r=-0.53) and NC (r=-0.47). TA values were lower in subjects with metabolic syndrome (P<0.0001). CONCLUSION Increased tongue adiposity is influenced by gender and is associated with abnormal upper airway patency and body composition parameters.
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Affiliation(s)
- Ivan R B Godoy
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Edgar Leonardo Martinez-Salazar
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alireza Eajazi
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pedro R Genta
- Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Hirata RP, Schorr F, Kayamori F, Moriya HT, Romano S, Insalaco G, Gebrim EM, de Oliveira LVF, Genta PR, Lorenzi-Filho G. Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy. J Clin Sleep Med 2016; 12:1339-1346. [PMID: 27448414 DOI: 10.5664/jcsm.6184] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/06/2016] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES There is a growing interest to develop a simple method to characterize the mechanisms leading to upper airway collapse in order to guide treatment options in patients with obstructive sleep apnea (OSA). Critical closing pressure (Pcrit) during sleep is able to predict the anatomical component of OSA. However, Pcrit is a laborious method that is only used for research purposes. The application of negative expiratory pressure (NEP) is a simple method to assess upper airway collapsibility that can be easily performed during wakefulness. We hypothesized that NEP will be, similarly to Pcrit, associated with upper airway anatomy assessed by computed tomography (CT) scan. METHODS Patients under investigation for OSA underwent polysomnography, CT of the upper airway, NEP while awake, and Pcrit during sleep. NEP was performed with -5 cm H2O in supine position using a nasal mask. Pcrit was measured during sleep induced by low doses of midazolam. RESULTS Twenty-eight male subjects were studied (age 45 ± 13 y, body mass index 29.4 ± 4.9 kg/m2, apnea-hypopnea index (AHI) 30 ± 26, range 2 to 86 events/h). NEP and Pcrit were similarly associated with tongue area (r = 0.646 and r = 0.585), tongue volume (r = 0.565 and r = 0.613) and pharyngeal length (r = 0.580 and r = 0.611), respectively (p < 0.05 for all comparisons). NEP and Pcrit were also significantly correlated with AHI (r = 0.490 and r = 0.531). NEP and Pcrit were significantly higher in patients with severe OSA than the remaining population. CONCLUSIONS NEP is a simple and promising method that is associated with the anatomical component of upper airway collapsibility. NEP may be valuable to select patients for noncontinuous positive airway pressure alternative therapies for OSA.
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Affiliation(s)
- Raquel P Hirata
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Fabiola Schorr
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Fabiane Kayamori
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | | | - Salvatore Romano
- Institute of Biomedicine and Molecular Immunology A. Monroy, Italian National Research Council, Palermo, Italy
| | - Giuseppe Insalaco
- Institute of Biomedicine and Molecular Immunology A. Monroy, Italian National Research Council, Palermo, Italy
| | - Eloisa M Gebrim
- Radiology Institute (InRad), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | | | - Pedro R Genta
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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49
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Measurement of Mandibular Volume for Anatomical Imbalance in OSA. Chest 2016; 149:1588. [DOI: 10.1016/j.chest.2016.03.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 03/21/2016] [Indexed: 12/11/2022] Open
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50
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Schorr F, Genta PR. Response. Chest 2016; 149:1588-9. [DOI: 10.1016/j.chest.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022] Open
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