Association of Naso-Oro-Pharyngeal Structures with the Sleep Architecture in Suspected Obstructive Sleep Apnea

Abstract

The study was conducted to find out the association of various naso-oro-pharyngeal structures with sleep macro-architecture in suspected obstructive sleep apnea subjects. Study included 51 subjects with suspected obstructive sleep apnea. Subjects with possible central apnea and those consuming any substance that can affect sleep architecture were excluded. Level I polysomnography was performed after thorough physical examination. Overnight study was scored in 30 s epochs to find out the polysomnographic variables. Surgical treatment was offered wherever indicated. Subjects with moderate to severe obstructive sleep apnea were manually titrated on CPAP with the polysomnogram. SPSS v 17.0 was used for statistical analysis. We did not find any difference in the sleep architecture between genders. Sleep Efficiency was better in subjects with dental overjet, dental attrition, high tongue base, macroglossia, lesser oral cavity volume, edematous uvula, increased submental fat, hypertrophied facial muscles and Mallampatti grade III-IV. Shorter Sleep Latency was seen in subjects with tender TMJ and Mallampatti Gr III-IV. REM latency was shorter in subjects with high tongue base, macroglossia and hypertrophied muscles of mastication. Increased REM was observed in subjects with high tongue base, edematous uvula and tender TMJ. Enlarged tonsils had reversed effect with poor sleep efficiency, increased REM latency and decreased REM. CPAP therapy (N = 20) lessened awake time, decreased N2 and increased REM. Oro-pharyngeal structures affect the sleep architecture in suspected OSA subjects. Nasal structures do not affect the sleep architecture in these subjects and enlarged tonsils have opposite effect. Sleep architecture changes on the titration night with CPAP.

Associations Between Sleep Quality, Sleep Architecture and Sleep Disordered Breathing and Memory After Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea in the Apnea Positive Pressure Long-term Efficacy Study (APPLES)

“…In the CPAP group, sleep duration and sleep quality as well as indices of sleep-related breathing disorder improved after this intervention; these changes were maintained for 6 months. Although these observations were expected [17][18][19][20] , not all studies have found that CPAP improves sleep quality 21 , and similar results from previous investigations were of shorter duration. Improvement in sleep architecture was correlated with CPAP adherence further strengthening a causal relationship.…”

Remote Controlled Mandibular Positional Device to Determine Oral Appliance Efficacy and Therapeutic Protrusive Position

“…Obviously there are high risks of increased upper airway collapsibility by existence of large tonsils [30][31][32] and macroglossia. 33,34 Mechanical Displacement of the Tongue Clinically, the tongue is frequently manipulated during surgical procedures in the mouth, with compression by instruments (tongue retractor) to avoid accidental injury by surgical instruments or to maintain the surgical view. In contrast to the beneficial effect of tongue protrusion on upper airway collapsibility 35 during sleep, downward displacement (retrograde) of the tongue in supine position might increase upper airway collapsibility during sleep.…”

Oral Health Implications of Obstructive Sleep Apnea: A Literature Review

“…The systemic character of oral health is highlighted by the interactions between OSA and many oral health issues, such as bruxism, xerostomia, periodontal disease, temporomandibular joint disorders, palatal and dental structural changes, and changes in taste perception [7][8][9][10][11][12][13][14]. Particularly noteworthy are the effects of palatal and dental abnormalities on the severity of OSA [15,16]. The nasal cavity may become narrowed by a high-arched, small palate, which can increase the risk of airway resistance and collapse.…”