Anatomical Balance of the Upper Airway and Obstructive Sleep Apnea

Tsuiki, Satoru; Isono, Shiroh; Ishikawa, Teruhiko; Yamashiro, Yuichiro; Tatsumi, Koichiro; Nishino, Takashi

doi:10.1097/aln.0b013e318173f103

Cited by 135 publications

(137 citation statements)

References 32 publications

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“…3 On the other hand, it was also suggested that an unfavorable relationship between the soft tissues and the bony enclosure size represents a possible anatomically based predisposition towards OSA. [27][28][29] Based on that, the need to evaluate the skeletal features in the treatment planning phases seems to emerge. Furthermore, it is important to point out that anatomical variables depend on ethnic differences.…”

Section: Discussionmentioning

confidence: 99%

Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies

Guarda-Nardini

Manfredini

Mion

et al. 2015

Journal of Clinical Sleep Medicine

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Aims:The aim of this review is to summarize data from the literature on the predictive value of anatomy-based parameters, as identifi ed by cephalometry, for the effi cacy of mandibular advancement devices (MAD) for the treatment of obstructive sleep apnea (OSA). Methods: Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The selected articles were methodologically evaluated. Results: Of an initial 311 references, 13 were selected that assessed correlations between polysomnographic and cephalometric variables. The majority of studies demonstrated a correlation between treatment effectiveness and features as determined by cephalometric analysis, such as the mandibular plane angle, hyoid bone distance to mandible, antero-posterior diameter of the maxilla, tongue area, cranial base, and soft palate. Conclusions:The mandibular plane angle and the distance between hyoid bone and mandibular plane was found to have a predictive value for MAD effectiveness in OSA patients. However, the relative weak and somewhat inconsistent cephalometric data suggest that decisions based solely on these factors cannot be recommended, especially because an integrated analysis of other risk factors (e.g., age, sex, BMI) should also be taken into account.

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Section: Discussionmentioning

confidence: 99%

Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies

Guarda-Nardini

Manfredini

Mion

et al. 2015

Journal of Clinical Sleep Medicine

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“…Shott and Donnelly (2004) observed 15 young patients with Down's syndrome after tonsillectomy with persistent upper airway obstruction and found that 80% exhibited tongue glossoptosis. Tsuiki et al (2008) reported that OSAHS patients have significantly larger tongues for a given maxillomandible size than non-OSAHS subjects. However, because of technical limitations, dynamic changes in tongue shape and position during sleep are seldom reported (Shott and Donnelly, 2004;Fricke et al, 2006;Zhang et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Dynamic alterations of the tongue in obstructive sleep apnea-hypopnea syndrome during sleep: analysis using ultrafast MRI

Wang¹,

McDonald²,

Liu³

et al. 2014

Genet. Mol. Res.

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ABSTRACT.Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) were evaluated using ultrafast magnetic resonance imaging (UMRI) while asleep and awake to analyze tongue changes. The upper airway of 21 OSAHS patients and 20 normal controls were examined during sleep using UMRI. A series of midline sagittal images of the upper airway were obtained to measure dynamic changes in tongue size and the distance from the tongue to the x-axis (an extended line from the anterior nasal spine to posterior nasal spine) and the y-axis (a perpendicular line from the center of the pituitary to the x-axis). The maximum and minimum sagittal Dynamic changes of the tongue in OSAHS during sleep diameters of the tongue were shorter in the OSAHS group than in the control group (P < 0.01) while awake, whereas the difference between the maximum and minimum vertical diameters of the tongue and the upper and central part of tongue between the posterior border and the retropharyngeal wall were greater (P < 0.05). During sleep, the maximum values and differences between the maximum and minimum tongue sizes in the OSAHS group were larger than in the control group (P < 0.05), whereas the minimum values were lower than in the control group (P < 0.01). Tongue size significantly differs between OSAHS patients and normal controls during sleep. The tongue tends to move downward during OSAHS, which may be attributed to increased upper airway resistance.

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“…These results are in line with studies showing that tongue dimensions and pharyngeal length also contribute to increase the risk of upper airway collapse during sleep. 4,7,[25][26][27] In addition, a lower positioned hyoid bone is the most commonly reported cephalometric abnormality among patients with OSA. Hyoid bone position also has a close relationship with OSA severity.…”

Section: Discussionmentioning

confidence: 99%

Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy

Hirata

Schorr

Kayamori

et al. 2016

Journal of Clinical Sleep Medicine

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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 H 2 O 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/m 2 , 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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Anatomical Balance of the Upper Airway and Obstructive Sleep Apnea

Abstract: Upper airway anatomical imbalance is involved in the pathogenesis of OSA.

Cited by 135 publications

References 32 publications

Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies

Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies

Dynamic alterations of the tongue in obstructive sleep apnea-hypopnea syndrome during sleep: analysis using ultrafast MRI

Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy

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