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Rachmawati EZK, Tamin S, Fardizza F, Yunizaf R, Putranto FM, Rizki NA, Wardani RS. Types of Epiglottic Collapse in Breathing Sleep Disorder and Their Impact in Clinical Practice. Int Arch Otorhinolaryngol 2024; 28:e255-e262. [PMID: 38618588 PMCID: PMC11008943 DOI: 10.1055/s-0043-1776719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/29/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is a severe form of sleep-disordered breathing (SDB) that is strongly correlated with comorbidities, in which epiglottic collapse (EC) and other contributing factors are involved. Objectives To evaluate the occurrence of EC in OSA patients through drug-induced sleep endoscopy (DISE) and to determine the factors contributing to EC. Methods A retrospective study of 37 adult patients using medical history. Patients were assessed for laryngopharyngeal reflux (LPR) and lingual tonsil hypertrophy (LTH) using reflux symptom index and reflux finding score (RFS); for OSA using polysomnography, and for airway collapse through DISE. An independent t -test was performed to evaluate risk factors, including the involvement of three other airway structures. Results Most EC patients exhibited trap door epiglottic collapse (TDEC) (56.8%) or pushed epiglottic collapse (PEC) (29.7%). Lingual tonsil hypertrophy, RFS, and respiratory effort-related arousal (RERA) were associated with epiglottic subtypes. Laryngopharyngeal reflux patients confirmed by RFS (t(25) = -1.32, p = 0.197) tended to suffer PEC; LTH was significantly associated (X2(1) = 2.5, p = 0.012) with PEC (odds ratio [OR] value = 44) in grades II and III LTH patients; 11 of 16 TDEC patients had grade I LTH. Pushed epiglottic collapse was more prevalent among multilevel airway obstruction patients. A single additional collapse site was found only in TDEC patients. Conclusion Laryngopharyngeal reflux causes repetitive acid stress toward lingual tonsils causing LTH, resulting in PEC with grade II or III LTH. Trap door epiglottic collapse requires one additional structural collapse, while at least two additional collapse sites were necessary to develop PEC. Respiratory effort-related arousal values may indicate EC.
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Affiliation(s)
- Elvie Zulka Kautzia Rachmawati
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Susyana Tamin
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fauziah Fardizza
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rahmanofa Yunizaf
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fikri Mirza Putranto
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Universitas Indonesia Hospital, Depok, Indonesia
| | - Niken Ageng Rizki
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Retno S. Wardani
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Kravietz A, Crosby T, Yang J, Balou S, Dion GR, Logan A, Amin MR. A Large Cohort Analysis of Epiglottic Phenotypes and Pharyngeal Residue. Ann Otol Rhinol Laryngol 2024; 133:375-383. [PMID: 38197379 DOI: 10.1177/00034894231218892] [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] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To describe the phenotypic characteristics of the epiglottis at rest and their impact on vallecular residue. METHODS Videofluoroscopic studies (VFSS) were pooled from 2 Laryngology practices, and Image J was used to measure epiglottic anatomic features at rest. Studies were rated by the MBSImp and presence of vallecular residue following swallow of thin and puree boluses. A conditional inference tree analysis was performed to isolate which epiglottic parameters were risk factors for presence of vallecular reside followed by logistic regression. RESULTS The majority of patients had a normal shaped epiglottis, followed by omega shape. The mean angle of the epiglottis from the hyoid was approximately 90°. Only abnormal epiglottic movement was associated with increased risk of residue for thin boluses (OR 35.09, CI 10.93-158.66, P < .001). However, in those with normal epiglottic movement, age >70 years old was associated with increased risk of residue (OR 3.98, CI 1.73-9.23, P = .001). For puree boluses, a normal or omega shaped epiglottis was associated with residue (OR 5.19, CI 2.41-11.51, P < .001), and this relationship was further modulated by increased distance of the epiglottic tip from the posterior pharyngeal wall. No other anatomic features of the resting epiglottis were associated with residue. Comorbidities potentially affecting swallow were infrequent in the cohort and were not associated with residue. CONCLUSION Abnormal epiglottic movement is associated with aspiration, and in this study we find that abnormal epiglottic movement increases the risk of vallecular residue and that older age is a risk factor for residue. The resting properties of the epiglottis do not appear to be associated with abnormal epiglottic movement or residue.
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Affiliation(s)
- Adam Kravietz
- Department of Otolaryngology/Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Tyler Crosby
- Department of Otolaryngology/Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jackie Yang
- New York University Grossman School of Medicine, New York, NY, USA
| | - Stamatela Balou
- New York University Grossman School of Medicine, New York, NY, USA
| | - Gregory R Dion
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley Logan
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Milan R Amin
- Department of Otolaryngology/Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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Hamdan AL, Hosri J, Abou Raji Feghali P, Abou Chaar J, Nawfal N, Alam E. Arytenoid Cartilage Collapse During Inhalation in Awake Patients with Intermediate/High Risk of Obstructive Sleep Apnea: A Retrospective Analysis of Sixty-Four Patients. J Voice 2024:S0892-1997(24)00015-8. [PMID: 38342646 DOI: 10.1016/j.jvoice.2024.01.012] [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: 10/26/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To assess the prevalence of arytenoid cartilage collapse (ACC) during deep inhalation in awake patients with intermediate/high risk of obstructive sleep apnea (OSA). STUDY DESIGN Retrospective case-control study. METHODS The medical records and video recordings of awake flexible endoscopic examination of patients with history of OSA who presented to the sleep apnea clinic in a tertiary referral medical center between June 2022 and December 2022, were reviewed. All patients had filled the STOP-BANG questionnaire and had intermediate/high risk of having OSA. A group of patients matched by age and gender and with no history of OSA were used as controls. RESULTS A total of 95 patients, 64 with a history of OSA and 31 with no history of OSA, were included. Among the study group, 37.5% (n = 24) had a STOP-BANG score between 3 and 4 and were considered to be at an intermediate risk of OSA while the remaining had a score more than 5 and were considered to be at high risk of OSA. There was a significant difference in the prevalence of ACC between the study group and controls (32.8% vs 12.9%, respectively, P < 0.001). CONCLUSION The prevalence of ACC was significantly higher in patients with intermediate/high risk of OSA in comparison to healthy controls with no history of OSA. When present, ACC should raise the physician's suspicion for OSA and probably prompt further investigation such as a sleep study.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jad Hosri
- Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Patrick Abou Raji Feghali
- Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jonathan Abou Chaar
- Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nader Nawfal
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Elie Alam
- Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Hsu WH, Yang CC, Tsai CY, Majumdar A, Lee KY, Feng PH, Tseng CH, Chen KY, Kang JH, Lee HC, Wu CJ, Kuan YC, Liu WT. Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution. Life (Basel) 2023; 13:life13051218. [PMID: 37240863 DOI: 10.3390/life13051218] [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: 03/19/2023] [Revised: 04/20/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships of body fat and water distribution with polysomnography parameters by using data from a sleep center database. The derived data were classified as those for low-ArTH in accordance with criteria that considered oximetry and the frequency and type fraction of respiratory events and analyzed using mean comparison and regression approaches. The low-ArTH group members (n = 1850) were significantly older and had a higher visceral fat level, body fat percentage, trunk-to-limb fat ratio, and extracellular-to-intracellular (E-I) water ratio compared with the non-OSA group members (n = 368). Significant associations of body fat percentage (odds ratio [OR]: 1.58, 95% confident interval [CI]: 1.08 to 2.3, p < 0.05), trunk-to-limb fat ratio (OR: 1.22, 95% CI: 1.04 to 1.43, p < 0.05), and E-I water ratio (OR: 1.32, 95% CI: 1.08 to 1.62, p < 0.01) with the risk of low-ArTH OSA were noted after adjustments for sex, age, and body mass index. These observations suggest that increased truncal adiposity and extracellular water are associated with a higher risk of low-ArTH OSA.
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Affiliation(s)
- Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Cheng-Chang Yang
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110301, Taiwan
| | - Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Arnab Majumdar
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Jiunn-Horng Kang
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110301, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Yi-Chun Kuan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110301, Taiwan
- Dementia Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Sleep Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Sleep Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
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Hanif U, Kiaer EK, Capasso R, Liu SY, Mignot EJM, Sorensen HBD, Jennum P. Automatic scoring of drug-induced sleep endoscopy for obstructive sleep apnea using deep learning. Sleep Med 2023; 102:19-29. [PMID: 36587544 DOI: 10.1016/j.sleep.2022.12.015] [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: 09/22/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment of obstructive sleep apnea is crucial for long term health and reduced economic burden. For those considered for surgery, drug-induced sleep endoscopy (DISE) is a method to characterize location and pattern of sleep-related upper airway collapse. According to the VOTE classification system, four upper airway sites of collapse are characterized: velum (V), oropharynx (O), tongue (T), and epiglottis (E). The degree of obstruction per site is classified as 0 (no obstruction), 1 (partial obstruction), or 2 (complete obstruction). Here we propose a deep learning approach for automatic scoring of VOTE obstruction degrees from DISE videos. METHODS We included 281 DISE videos with varying durations (6 s-16 min) from two sleep clinics: Copenhagen University Hospital and Stanford University Hospital. Examinations were split into 5-s clips, each receiving annotations of 0, 1, 2, or X (site not visible) for each site (V, O, T, and E), which was used to train a deep learning model. Predicted VOTE obstruction degrees per examination was obtained by taking the highest predicted degree per site across 5-s clips, which was evaluated against VOTE degrees annotated by surgeons. RESULTS Mean F1 score of 70% was obtained across all DISE examinations (V: 85%, O: 72%, T: 57%, E: 65%). For each site, sensitivity was highest for degree 2 and lowest for degree 0. No bias in performance was observed between videos from different clinicians/hospitals. CONCLUSIONS This study demonstrates that automating scoring of DISE examinations show high validity and feasibility in degree of upper airway collapse.
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Affiliation(s)
- Umaer Hanif
- Biomedical Signal Processing & AI Research Group, Department of Health Technology, Technical University of Denmark, Oersteds Plads 345B, 2800, Kongens Lyngby, Denmark; Stanford University Center for Sleep and Circadian Sciences, Stanford University, 3165 Porter Dr., CA, 94304, Palo Alto, USA; Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark.
| | - Eva Kirkegaard Kiaer
- Danish Center for Sleep Surgery, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital (Rigshospitalet), Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.
| | - Robson Capasso
- Department of Otolaryngology/Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA, 94304, USA.
| | - Stanley Y Liu
- Department of Otolaryngology/Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA, 94304, USA.
| | - Emmanuel J M Mignot
- Stanford University Center for Sleep and Circadian Sciences, Stanford University, 3165 Porter Dr., CA, 94304, Palo Alto, USA.
| | - Helge B D Sorensen
- Biomedical Signal Processing & AI Research Group, Department of Health Technology, Technical University of Denmark, Oersteds Plads 345B, 2800, Kongens Lyngby, Denmark.
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark.
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Webb AL, Lynch JT, Pickering MR, Perriman DM. Shape modelling of the oropharynx distinguishes associations with body morphology but not whiplash-associated disorder. J Anat 2022; 242:535-543. [PMID: 36300770 PMCID: PMC9919469 DOI: 10.1111/joa.13783] [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: 06/27/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
Characterization of the oropharynx, a subdivision of the pharynx between the soft palate and the epiglottis, is limited to simple measurements. Structural changes in the oropharynx in whiplash-associated disorder (WAD) cohorts have been quantified using two-dimensional (2D) and three-dimensional (3D) measures but the results are inconsistent. Statistical shape modelling (SSM) may be a more useful tool for systematically comparing morphometric features between cohorts. This technique has been used to quantify the variability in boney and soft tissue structures, but has not been used to examine a hollow cavity such as the oropharynx. The primary aim of this project was to examine the utility of SSM for comparing the oropharynx between WAD cohorts and control; and WAD severity cohorts. The secondary aim was to determine whether shape is associated with sex, height, weight and neck length. Magnetic resonance (MR) T1-weighted images were obtained from healthy control (n = 20), acute WAD (n = 14) and chronic WAD (n = 14) participants aged 18-39 years. Demographic, WAD severity (neck disability index) and body morphometry data were collected from each participant. Manual segmentation of the oropharynx was undertaken by blinded researchers between the top of the soft palate and tip of the epiglottis. Digital 3D oropharynx models were constructed from the segmented images and principal component (PC) analysis was performed with the PC weights normalized to z-scores for consistency. Statistical analyses were undertaken using multivariate linear models. In the first statistical model the independent variable was group (acute WAD, chronic WAD, control); and in the second model the independent variable was WAD severity (recovered/mild, moderate/severe). The covariates for both models included height, weight, average neck length and sex. Shape models were constructed to visualize the effect of perturbing these covariates for each relevant mode. The shape model revealed five modes which explained 90% of the variance: mode 1 explained 59% of the variance and primarily described differences in isometric size of the oropharynx, including elongation; mode 2 (13%) primarily described lateral (width) and AP (depth) dimensions; mode 3 (8%) described retroglossal AP dimension; mode 4 (6%) described lateral dimensions at the retropalatal-retroglossal junction and mode 5 (4%) described the lateral dimension at the inferior retroglossal region. There was no difference in shape (mode 1 p = 0.52; mode 2 p = 0.96; mode 3 p = 0.07; mode 4 p = 0.54; mode 5 p = 0.74) between control, acute WAD and chronic WAD groups. There were no statistical differences for any mode (mode 1 p = 0.12; mode 2 p = 0.29; mode 3 p = 0.56; mode 4 p = 0.99; mode 5 p = 0.96) between recovered/mild and moderate/severe WAD. Sex was not significant in any of the models but for mode 1 there was a significant association with height (p = 0.007), mode 2 neck length (p = 0.044) and in mode 3 weight (p = 0.027). Although SSM did not detect differences between WAD cohorts, it did detect associations with body morphology indicating that it may be a useful tool for examining differences in the oropharynx.
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Affiliation(s)
- Alexandra L. Webb
- Medical School, College of Health and MedicineAustralian National UniversityCanberra, ACTAustralia
| | - Joseph T. Lynch
- Medical School, College of Health and MedicineAustralian National UniversityCanberra, ACTAustralia,Trauma and Orthopaedic Research Unit, Canberra Health ServicesCanberra, ACTAustralia
| | - Mark R. Pickering
- School of Engineering and Information TechnologyUniversity of New South WalesCanberra, ACTAustralia
| | - Diana M. Perriman
- Medical School, College of Health and MedicineAustralian National UniversityCanberra, ACTAustralia,Trauma and Orthopaedic Research Unit, Canberra Health ServicesCanberra, ACTAustralia
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Li T, Tan L, Furian M, Zhang Y, Luo L, Lei F, Xue X, He J, Tang X. Sex-Specific Difference in the Effect of Altitude on Sleep and Nocturnal Breathing in Young Healthy Volunteers. J Clin Med 2022; 11:jcm11102869. [PMID: 35628996 PMCID: PMC9143383 DOI: 10.3390/jcm11102869] [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: 03/22/2022] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023] Open
Abstract
Importance: To date, there is no established evidence of sex-specific differences in altitude-induced sleep-disordered breathing (SDB) during polysomnography-confirmed sleep. Objective: The aim of this study was to investigate whether differences in sex play a pivotal role in incidences of SDB and acute mountain sickness (AMS) when staying overnight at high altitude. Design: This was a prospective cohort study. Setting: Participants underwent overnight polysomnography (PSG) and clinical assessment in a sleep laboratory at 500 m and two consecutive days at 3270 m. Participants: The participants comprised 28 (18 women) healthy, young, low-altitude residents with a median (interquartile range) age of 26.0 (25.0, 28.0) years. Exposures: Altitude exposure. Main outcomes and Measures: The primary outcome was altitude-induced change in the PSG-confirmed apnea−hypopnea index (AHI) at 3270 m compared to 500 m between men and women. Secondary outcomes included sex differences in other parameters related to SDB, sleep structure, AMS, psychomotor vigilance test reaction time and parameters from arterial and venous blood analyses. Results: The median (interquartile range) AHIs at 500 m and 3270 m on night 1 and on night 2 were 6.5/h (3.6, 9.1), 23.7/h (16.2, 42.5) and 15.2/h (11.8, 20.9) in men, respectively, and 2.2/h (1.0, 5.5), 8.0/h (5.3, 17.0) and 7.1/h (4.9, 11.5) in women, respectively (p < 0.05 nights 1 and 2 at 3270 m vs. 500 m in men and women). The median difference (95% CI) of altitude-induced change in AHI (3270 m night 1 compared to 500 m) between men and women was 11.2/h (1.9 to 19.6) (p < 0.05). Over the time course of 2 days at 3270 m, 9 out of 18 (50%) women and 1 out of 10 (10%) men developed AMS (p < 0.05 women versus men). Conclusions and Relevance: This prospective cohort study showed that men were more susceptible to altitude-induced SDB but that they had a lower AMS incidence when staying for 2 days at 3270 m than women. These findings indicate that sex-related prevention and intervention strategies against SDB and AMS are highly warranted. Trial Registration: This trial was registered at the Chinese Clinical Trial Registry; No. ChiCTR1800020155.
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Affiliation(s)
- Taomei Li
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Lu Tan
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Michael Furian
- Sleep Disorders Center, Department of Respiratory Medicine, University Hospital of Zurich, 8091 Zurich, Switzerland;
| | - Yanyan Zhang
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Lian Luo
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Fei Lei
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
| | - Xiaofang Xue
- Department of Cardiology, Diqing Tibetan Autonomous Prefectural People’s Hospital, Shangri-La 674400, China; (X.X.); (J.H.)
| | - Jiaming He
- Department of Cardiology, Diqing Tibetan Autonomous Prefectural People’s Hospital, Shangri-La 674400, China; (X.X.); (J.H.)
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; (T.L.); (L.T.); (Y.Z.); (L.L.); (F.L.)
- Correspondence: ; Tel.: +86-28-85422733; Fax: +86-28-85422632
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Zhang W, Gao X. A Cone Beam CT Study of Upper Airway Morphology in Perimenopausal and Postmenopausal Women. Int J Womens Health 2021; 13:1129-1137. [PMID: 34853538 PMCID: PMC8627894 DOI: 10.2147/ijwh.s335728] [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: 08/24/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Menopause is accompanied by a decline in estrogen and progesterone. Several studies have demonstrated that upper airway patency decreases in women after menopause, while morphology changes are still a lack of evidence. This study aimed to explore upper airway morphology changes in perimenopausal and postmenopausal women. Methods This retrospective cross-sectional study included 367 consecutive Chinese female patients over 25 years old who had routinely taken large-field cone beam computed tomography in the imaging library of Peking University School and Hospital of Stomatology from October 2016 to September 2020. A total of 283 males were screened as sex controls according to the same age group. Upper airway morphology, hyoid position and facial pattern were measured. The association between perimenopausal and postmenopausal years and upper airway morphology in both sexes was analyzed. Results Perimenopausal women (aged 45-54 years) showed a significant decrease in the volume (3172.91mm3, 95% CI = 653.86-5691.96) and minimum cross-sectional area (37.08 mm2, 95% CI = 5.36-68.80), and a significant increase in the length (-1.96mm, 95% CI = -3.62 to -0.29) of upper airway compared to adjacent reproductive years (aged 35-44), while this difference was neither seen in other adjacent two reproductive age groups of females nor in the same age groups of males. In postmenopausal women (55 years and older), hyoid position was significantly lower (-2.74mm, 95% CI = -4.42 to -1.07) than either age group, while no similar changes were seen in men. Conclusion Women had smaller airway volume, reduced upper airway cross-sectional area and longer airway length in perimenopausal years, and a significantly lower hyoid position in postmenopausal years. These changes may be related to menopause itself and independent of the changes associated with aging.
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Affiliation(s)
- Wanxin Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
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Chen J, Chen C, Xu W, Zhang X. Size selection of the Ambu AuraOnce laryngeal mask in Chinese men weighing >70 kg: a pilot study. J Int Med Res 2021; 49:3000605211016689. [PMID: 34024169 PMCID: PMC8142532 DOI: 10.1177/03000605211016689] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To collect computed tomography data of the laryngeal anatomy of Chinese men and to determine the feasibility of using the size 4 Ambu AuraOnce laryngeal mask (Ambu A/S, Copenhagen, Denmark) in Chinese men weighing >70 kg. METHODS This prospective study involved men who underwent surgery from May 2018 to January 2019 at Jinshan Hospital. Pharyngeal and laryngeal parameters were measured by computed tomography. The laryngeal mask insertion success rate, requirement for tracheal tube insertion, laryngeal mask insertion time, fiberoptic bronchoscopy grading, air leakage pressure, and pharyngeal complications were analyzed. RESULTS In a comparison of the size 4 and 5 Ambu AuraOnce devices, the first insertion success rate was 100% and 87% and the three-times insertion success rate was 100% and 93%, respectively, with no significant differences. However, the insertion time was significantly different at 19.6 ± 5.9 versus 31.1 ± 11.2 s, respectively, and the proportions of fiberoptic grading levels were also significantly different. There were no significant differences in the air leakage pressure or pharyngeal complications. CONCLUSION The size 4 Ambu AuraOnce is more adequate than the size 5 for Chinese men weighing >70 kg, with a shorter insertion time and higher fiberoptic bronchoscopic grading.
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Affiliation(s)
- Jiahui Chen
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Chunhuan Chen
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Wei Xu
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xiaoguang Zhang
- Department of Anesthesiology, Jinshan Hospital of Fudan University, Shanghai, China
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10
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"Hidden in Plain Sight": A Descriptive Review of Laryngeal Vestibule Closure. Dysphagia 2018; 34:281-289. [PMID: 30062547 DOI: 10.1007/s00455-018-9928-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
A major emphasis in the evaluation of swallowing is to identify physiological abnormalities in swallowing that contribute to or explain unsafe swallowing (i.e., ingested material enters the trachea; post-swallow residue in the pharynx). Impairments in laryngeal vestibule closure are widely recognized as one of the major causes of unsafe swallowing, as it is the primary mechanism and first line of defense for preventing material from penetrating the airway during swallowing. However, this complex mechanism is often overlooked and understudied in swallowing research and dysphagia management. The purpose of this review is to promote a better understanding of the mechanism of laryngeal vestibule closure. We discuss where gaps in research exist and propose future directions for incorporating laryngeal vestibule closure as a primary outcome measure in swallowing research. Additionally, we propose that an increased knowledge of the mechanism of laryngeal vestibule closure will increase diagnostic accuracy and optimize dysphagia management for patients with dysphagia.
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11
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Roustan V, Barbieri M, Incandela F, Missale F, Camera H, Braido F, Mora R, Peretti G. Transoral glossoepiglottopexy in the treatment of adult obstructive sleep apnoea: a surgical approach. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 38:38-44. [PMID: 29756614 DOI: 10.14639/0392-100x-1857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/01/2017] [Indexed: 01/07/2023]
Abstract
SUMMARY The treatment of obstructive sleep apnoea syndrome (OSAS) is still a matter of debate; among the different therapeutic alternatives, both surgical and conservative, treatment with continuous positive airway pressure (CPAP) is considered the "gold standard". The recent scientific literature reports that even if CPAP represents an effective solution for sleep apnoeas, 12% of patients do not benefit from its use. In most cases, primary collapse of the epiglottis is responsible for failure. We developed a surgical technique that provides a stable support to the epiglottis without influencing its function during swallowing while preserving laryngeal anatomy and physiology. The procedure we propose is based on that conceived by Monnier for children affected by laryngomalacia. We analysed a group of 20 patients who underwent glossoepiglottopexy between January 2015 and September 2016 and compared data (AHI, ODI, t90, ESS, EAT10, etc.) collected before and 6 months after surgery to demonstrate the safety and effectiveness of our glossoepiglottopexy (GEP). The results allow us to consider GEP as a valid choice to treat adults who suffer from sleep apnoeas.
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Affiliation(s)
- V Roustan
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Genoa, IRCCS AUO San Martino-IST, Genoa, Italy
| | - M Barbieri
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Genoa, IRCCS AUO San Martino-IST, Genoa, Italy
| | - F Incandela
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Genoa, IRCCS AUO San Martino-IST, Genoa, Italy
| | - F Missale
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Genoa, IRCCS AUO San Martino-IST, Genoa, Italy
| | - H Camera
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Genoa, IRCCS AUO San Martino-IST, Genoa, Italy
| | - F Braido
- Allergy and Respiratory Diseased Clinic DIMI, University of Genoa, IRCCS AUO San Martino-IST, Genoa, Italy
| | - R Mora
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Genoa, IRCCS AUO San Martino-IST, Genoa, Italy
| | - G Peretti
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Genoa, IRCCS AUO San Martino-IST, Genoa, Italy
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12
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Annual review of selected scientific literature: Report of the committee on scientific investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2017; 118:281-346. [DOI: 10.1016/j.prosdent.2017.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 01/19/2023]
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13
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Gaines J, Vgontzas AN, Fernandez-Mendoza J, He F, Calhoun SL, Liao D, Bixler EO. Increased inflammation from childhood to adolescence predicts sleep apnea in boys: A preliminary study. Brain Behav Immun 2017; 64:259-265. [PMID: 28432036 PMCID: PMC7085276 DOI: 10.1016/j.bbi.2017.04.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/11/2017] [Accepted: 04/15/2017] [Indexed: 02/06/2023] Open
Abstract
While chronic systemic inflammation in obstructive sleep apnea (OSA) has been traditionally considered a consequence of intermittent hypoxia, several treatment studies targeting inflammation suggest that this process may precede the development of the disorder. A recent cross-sectional study in the Penn State Child Cohort (PSCC) revealed that inflammation largely mediates the association between visceral adiposity and OSA in adolescence. The purpose of this study was to examine for the first time whether, longitudinally, inflammation precedes OSA during this developmental period. A subsample of the PSCC with longitudinal sleep and inflammation data (n=51) was included in this study. Participants underwent 9-h polysomnography (22:00-7:00), physical exam, and fasting morning blood draw at both time points. Plasma C-reactive protein (CRP) was measured via ELISA. At follow-up, visceral, subcutaneous, and total fat area were assessed via dual X-ray absorptiometry. Sex differences in body composition emerged in adolescence, with boys having more visceral adiposity than girls. Longitudinal increases in waist circumference from childhood to adolescence were associated with increases in CRP (ΔCRP) and follow-up CRP in boys, but not girls. Furthermore, in boys, ΔCRP was associated with higher follow-up apnea/hypopnea index (AHI). When ΔCRP was entered into a model predicting follow-up AHI, Δwaist circumference was no longer significant, indicating that inflammation largely explains the association between increasing central obesity and OSA severity. These preliminary findings, in a longitudinal, non-clinical sample of children developing OSA, suggest that inflammation derived from visceral adipose tissue precedes the development of the disorder, suggesting a potential causal mechanism.
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Affiliation(s)
- Jordan Gaines
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Alexandros N. Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States,Corresponding author at: Penn State University College of Medicine, Department of Psychiatry H073, 500 University Drive, Hershey, PA 17033, United States. (A.N. Vgontzas)
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Fan He
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Susan L. Calhoun
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Edward O. Bixler
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States
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