Assessment of 3-D nasal airway morphology in Southeast Asian adults with obstructive sleep apnea using acoustic rhinometry

Abstract

The aim of the present study is to investigate nasal airway morphology in Asian adults with and without obstructive sleep apnea (OSA) using acoustic rhinometry (AR), principal components analysis (PCA), and 3-D finite-element analysis (FEA). One hundred eight adult Malays aged 18-65 years (mean ± SD, 33.2 ± 13.31) underwent clinical examination and limited channel polysomnography, providing 54 patients with OSA and 54 non-OSA controls. The mean minimal cross section area 1 (MCA1) and the mean minimal cross sectional area 2 (MCA2) were obtained from AR for all subjects and subjected to t tests. The OSA and control nasal airways were reconstructed in 3-D and subjected to PCA and FEA. The mean MCA1 and MCA2 using AR were found to be significantly smaller in the OSA group than in the control group (p < 0.001). Comparing the 3-D OSA and control nasal airways using PCA, the first two eigenvalues accounted for 94% of the total shape change, and statistical differences were found (p < 0.05). Similarly, comparing the nasal airways using FEA, the 3-D mean OSA nasal airway was significantly narrower in the OSA group compared to the control group. Specifically, decreases in size of approx. 10-22% were found in the nasal valve/head of inferior turbinate area. In conclusion, differences in nasal airway morphology are present when comparing patients with OSA to controls. These differences need to be recognized as they can improve our understanding of the etiological basis of obstructive sleep apnea and facilitate its subsequent management.

Comparison of nasal geometry among adults with obstructive sleep apnea: a preliminary study

“…Moreover, it is important to note that the group of patients evaluated in the aforementioned study consisted of almost 70% of individuals with severe OSA 8 , which may also explain the difference in results in relation to the present study which refer to CSA2.…”

“…It is known that the etiology of OSA is multifactorial and that morphometric and functional changes in oropharyngeal and nasal structures are among the cause and effect processes of OSA 6,7 . These changes promote upper airways (UAW) narrowing, one of the main factors for the emergence of this disorder [6][7][8] .…”

“…The gold-standard method for OSA diagnosis is polysomnography 11 . However, other screening procedures may be useful for combining different risk factors 12 , such as airway abnormalities, including examinations that assess nasal cavity geometry 8,13 .…”

“…Acoustic rhinometry (AR) is characterized by a procedure to measure nasal geometry, which means the volumes, areas and distances of the nasal cavity cross-sections, enabling identification of possible obstructions 8,13 . In this context, AR can to identify risk factors for developing and aggravating OSA related to nasal cavity obstructions, and may be adopted as an auxiliary method in order to detect anatomical changes which accompany the onset and evolution of the disease 8,13 .…”

Maxillary Expansion may Increase Airway Dimensions and Improve Breathing

“…For instance, studies in obstructive sleep apnea (OSA) and nasal anatomy have demonstrated that changes in nasal anatomy have a relationship with OSA. 10,11 In the ''Methods'' section, the authors used the methodological-quality score protocol designed by Lagravere et al 1 and applied by them in a systematic review of the long-term dental changes after RME. This is an interesting instrument to analyze the different studies using RME, but we have to look at it very carefully.…”