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Location of the narrowest area of the pharynx regarding body mass index and obstructive sleep apnoea severity
Affiliations- Department of Orthodontics, Warsaw Medical University, Warsaw, Poland, Poland
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Abstract
Background: Among authors studying morphological determinants of the obstructive sleep apnoea (OSA) controversies exist on the location of the narrowest area within the pharynx, critical for development of obstruction. Those disagreements primarily revolve around differences between obese and nonobese OSA patients. Determination whether the location and size of the narrowest area within the pharynx differentiates the obese and nonobese OSA patients.
Materials and methods: A population of 55 subjects was investigated after being diagnosed with OSA in the Polysomnography Laboratory of the Department and Clinic of Otolaryngology in the Medical University of Warsaw, Poland. Additionally a head computed tomography (CT) was performed in all the subjects. The CT images were used to do several crucial measurements which described the geometry of the facial skeleton as well as soft tissues of the head. The obtained results were correlated with apnoea-hypopnoea index (AHI) and body mass index (BMI) values. The data were statistically analysed.
Results: The distance between the hard palate and posterior pharyngeal wall parallel to the horizontal plane as well as the shortest distance between the soft palate and posterior pharyngeal wall significantly differentiated patients in the subgroups by AHI but not by BMI.
Conclusions: Pharyngeal obstruction at the level of the hard and soft palate differentiates patients with severe OSA from patients with mild and moderate OSA regardless of BMI.
Abstract
Background: Among authors studying morphological determinants of the obstructive sleep apnoea (OSA) controversies exist on the location of the narrowest area within the pharynx, critical for development of obstruction. Those disagreements primarily revolve around differences between obese and nonobese OSA patients. Determination whether the location and size of the narrowest area within the pharynx differentiates the obese and nonobese OSA patients.
Materials and methods: A population of 55 subjects was investigated after being diagnosed with OSA in the Polysomnography Laboratory of the Department and Clinic of Otolaryngology in the Medical University of Warsaw, Poland. Additionally a head computed tomography (CT) was performed in all the subjects. The CT images were used to do several crucial measurements which described the geometry of the facial skeleton as well as soft tissues of the head. The obtained results were correlated with apnoea-hypopnoea index (AHI) and body mass index (BMI) values. The data were statistically analysed.
Results: The distance between the hard palate and posterior pharyngeal wall parallel to the horizontal plane as well as the shortest distance between the soft palate and posterior pharyngeal wall significantly differentiated patients in the subgroups by AHI but not by BMI.
Conclusions: Pharyngeal obstruction at the level of the hard and soft palate differentiates patients with severe OSA from patients with mild and moderate OSA regardless of BMI.
Keywords
obstructive sleep apnoea, pharynx, computed tomography
About this articleTitle
Location of the narrowest area of the pharynx regarding body mass index and obstructive sleep apnoea severity
Journal
Issue
Article type
Original article
Pages
491-500
Published online
2017-02-15
Page views
1198
Article views/downloads
1186
DOI
Pubmed
Bibliographic record
Folia Morphol 2017;76(3):491-500.
Keywords
obstructive sleep apnoea
pharynx
computed tomography
Authors
M. Krasny
J. Wysocki
M. Prus
K. Niemczyk
References (33)- Chebbo A, Tfaili A, Ghamande S. Anatomy and physiology of obstructive sleep apnea. Sleep Med Clin. 2013; 8(4): 425–431.
- Cuccia AM, Campisi G, Cannavale R, et al. Obesity and craniofacial variables in subjects with obstructive sleep apnea syndrome: comparisons of cephalometric values. Head Face Med. 2007; 3: 41–50.
- Davies RJO, Stradling JR. The relationship between neck circumference, radiographic pharangeal anatomy, and the obstructive sleep apnoea syndrome. Eur Respir J. 1990; 3: 509–514.
- Dreher A, de la Chaux R, Klemens C, et al. Correlation between otorhinolaryngologic evaluation and severity of obstructive sleep apnea syndrome in snorers. Arch Otolaryngol Head Neck Surg. 2005; 131(2): 95–98.
- Fajdiga I. Snoring imaging: could Bernoulli explain it all? Chest. 2005; 128(2): 896–901.
- Finkelstein Y, Wexler D, Horowitz E, et al. Frontal and lateral cephalometry in patients with sleep-disordered breathing. Laryngoscope. 2001; 111(4): 634–641.
- Finkelstein Y, Wolf L, Nachmani A, et al. Velopharyngeal anatomy in patients with obstructive sleep apnea versus normal subjects. J Oral Maxillofac Surg. 2014; 72(7): 1350–1372.
- Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002; 127(1): 13–21.
- Haponik EF, Smith PL, Bohlman ME, et al. Computerized tomography in obstructive sleep apnea. Correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis. 1983; 127(2): 221–226.
- Hochban W, Brandenburg U. Morphology of the viscerocranium in obstructive sleep apnoea syndrome--cephalometric evaluation of 400 patients. J Craniomaxillofac Surg. 1994; 22(4): 205–213.
- Hou HM, Hägg U, Sam K, et al. Dentofacial characteristics of Chinese obstructive sleep apnea patients in relation to obesity and severity. Angle Orthod. 2006; 76(6): 962–969.
- Iida-Kondo C, Yoshino N, Kurabayashi T, et al. Comparison of tongue volume/oral cavity volume ratio between obstructive sleep apnea syndrome patients and normal adults using magnetic resonance imaging. J Med Dent Sci. 2006; 53(2): 119–126.
- Koren A, Groselj LD, Fajdiga I. CT comparison of primary snoring and obstructive sleep apnea syndrome: role of pharyngeal narrowing ratio and soft palate-tongue contact in awake patient. Eur Arch Otorhinolaryngol. 2009; 266(5): 727–734.
- Kubota Y, Nakayama H, Takada T, et al. Facial axis angle as a risk factor for obstructive sleep apnea. Intern Med. 2005; 44(8): 805–810.
- Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med. 1997; 127(8): 581–587.
- Li KK, Kushida C, Powell NB, et al. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope. 2000; 110(10 Pt 1): 1689–1693.
- Maltais F, Carrier G, Cormier Y, et al. Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea. Thorax. 1991; 46(6): 419–423.
- Mortimore IL, Marshall I, Wraith PK, et al. Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med. 1998; 157(1): 280–283.
- Nelson S, Hans M. Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest. 1997; 111(1): 154–162.
- Okubo M, Suzuki M, Horiuchi A, et al. Morphologic analyses of mandible and upper airway soft tissue by MRI of patients with obstructive sleep apnea hypopnea syndrome. Sleep. 2006; 29(7): 909–915.
- Pahkala R, Seppä J, Ikonen A, et al. The impact of pharyngeal fat tissue on the pathogenesis of obstructive sleep apnea. Sleep Breath. 2014; 18(2): 275–282.
- Rama AN, Tekwani SH, Kushida CA. Sites of obstruction in obstructive sleep apnea. Chest. 2002; 122(4): 1139–1147.
- Sakakibara H, Tong M, Matsushita K, et al. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J. 1999; 13(2): 403–410.
- Schellenberg JB, Maislin G, Schwab RJ. Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med. 2000; 162(2 Pt 1): 740–748.
- Schwab RJ. Imaging for the snoring and sleep apnea patient. Dent Clin North Am. 2001; 45(4): 759–796.
- Shigeta Y, Ogawa T, Ando E, et al. Influence of tongue/mandible volume ratio on oropharyngeal airway in Japanese male patients with obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 111(2): 239–243.
- Tangugsorn V, Skatvedt O, Krogstad O, et al. Obstructive sleep apnoea: a cephalometric study. Part I. Cervico-craniofacial skeletal morphology. Eur J Orthodont. 1995; 17(1): 45–56.
- Tsuchiya M, Lowe AA, Pae EK, et al. Obstructive sleep apnea subtypes by cluster analysis. Am J Orthod Dentofacial Orthop. 1992; 101(6): 533–542.
- Vos W, De Backer J, Devolder A, et al. Correlation between severity of sleep apnea and upper airway morphology based on advanced anatomical and functional imaging. J Biomech. 2007; 40(10): 2207–2213.
- Welch KC, Foster GD, Ritter CT, et al. A novel volumetric magnetic resonance imaging paradigm to study upper airway anatomy. Sleep. 2002; 25(5): 532–542.
- Wilhelm CP, deShazo RD, Tamanna S, et al. The nose, upper airway, and obstructive sleep apnea. Ann Allergy Asthma Immunol. 2015; 115(2): 96–102.
- Yagi H, Nakata S, Tsuge H, et al. Morphological examination of upper airway in obstructive sleep apnea. Auris Nasus Larynx. 2009; 36(4): 444–449.
- Yu X, Fujimoto K, Urushibata K, et al. Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome. Chest. 2003; 124(1): 212–218.
