Association of Backscattered Ultrasonographic Imaging of the Tongue With Severity of Obstructive Sleep Apnea in Adults

Abstract

ImportanceDetermining interventions to manage obstructive sleep apnea (OSA) depends on clinical examination, polysomnography (PSG) results, and imaging analysis. There remains the need of a noninvasive and cost-effective way to correlate relevant upper airway anatomy with severity of OSA to direct treatment and optimize outcome.ObjectiveTo determine whether backscattered ultrasonographic imaging (BUI) analysis of the tongue is associated with severity of OSA in adults.Design, Setting, and ParticipantsIn this prospective, single-center, diagnostic study of a consecutive series of patients (aged ≥18 years) at a sleep surgery clinic, the 89 included patients had a PSG within 3 years at the time of ultrasonography and BUI analysis between July 2020 and March 2022. Patients were excluded if body mass index had changed more than 10% since time of PSG. A standardized submental ultrasonographic scan with laser alignment was used with B-mode and BUI analysis applied to the tongue. The B-mode and BUI intensity were associated with the apnea-hypopnea index (AHI), a measure of severity of apnea from normal (no OSA) to severe OSA.ExposuresUltrasonography and PSG.Main Outcomes and MeasuresThe main outcomes were BUI parameters and their association with AHI value.ResultsEighty-nine patients were included between July 2020 and March 2022. A total of 70 (78.7%) male patients were included; and distribution by race and ethnicity was 46 (52%) White participants, 22 (25%) Asian participants, and 2 (2%) African American participants, and 19 (21%) others. Median (IQR) age was 37.0 (29.0-48.3) years; median (IQR) BMI was 25.3 (23.2-29.8); and median (IQR) AHI was 11.1 (5.6-23.1) events per hour. At the middle to posterior tongue region, the 4 OSA severity levels explained a significant portion of the BUI variance (η2 = 0.153-0.236), and a significant difference in BUI values was found between the subgroups with AHI values of less than 15 (no OSA and mild OSA) and greater than or equal to 15 (moderate OSA and severe OSA) events per hour. The echo intensity showed no significant differences. The BUI values showed a positive association with AHI, with a Spearman correlation coefficient of up to 0.43. Higher BUI values remained associated with higher AHI after correction for the covariates of BMI and age.Conclusions and RelevanceIn this prospective diagnostic study, standardized BUI analysis of the tongue was associated with OSA severity. With the practicality of ultrasonography, this analysis is pivotal in connecting anatomy with physiology in treatment planning for patients with OSA.

Relationship between Cephalometric and Ultrasonic Airway Parameters in Adults with High Risk of Obstructive Sleep Apnea

“…Therefore, some patients remain undiagnosed. On the contrary, the ultrasound imaging of airways has the advantages of being radiation-free, rapid, reproducible, accessible, affordable, and it can identify both structural and functional changes in the pharyngeal airways [24][25][26][27]32]. Therefore, it can enhance the early detection of those with unrecognized OSA.…”

“…Ultrasound has been increasingly utilized in recent years for OSA screening and upper airway obstruction localization. Ultrasonic imaging of airways has the advantages of being radiation-free, rapid, reproducible, accessible, affordable, and it can detect both anatomical and dynamic changes in pharyngeal airspace [ 24 , 25 ]. According to a systematic review and meta-analysis, the distance between lingual arteries (DLAs), tongue base thickness, retropalatal (RP) diameter, % RP diameter shortening during the Muller maneuver, lateral pharyngeal thickness (LPW), and upper airway (UA) length have a moderate correlation with moderate-to-severe OSA (r values ranging from 0.37 to 0.624) [ 26 ].…”

“…Upper airway width changes in all three regions (retropalatal, oropharyngeal, and retroglossal) are correlated with the apnea–hypopnea index (AHI) and the Oxygen Desaturation Index (ODI) [ 27 ]. Furthermore, backscattered imaging analysis of standardized tongue ultrasonography reveals a significant correlation with the severity of OSA [ 25 ].…”