CBCT assessment of upper airway changes and treatment outcomes of obstructive sleep apnoea: a systematic review

Alsufyani, Noura; Al-Saleh, M. A.; Major, Paul W.

doi:10.1007/s11325-012-0799-7

Cited by 80 publications

(65 citation statements)

References 38 publications

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“…Therefore it is highly important for the airway to be quantitatively studied as a complete structure. Both MRI and CT imaging have been used to generate full volumetric models of the upper airway for the study of airway obstructions25262728, however neither are particularly practical as standard screening measures. MRI can provide dynamic high resolution and high contrast visualizations of the airway lumen but the exceedingly high cost per study and limited accessibility precludes its adoption for widespread airway imaging.…”

Section: Discussionmentioning

confidence: 99%

Anatomically correct visualization of the human upper airway using a high-speed long range optical coherence tomography system with an integrated positioning sensor

Jing

Chou

et al. 2016

Sci Rep

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The upper airway is a complex tissue structure that is prone to collapse. Current methods for studying airway obstruction are inadequate in safety, cost, or availability, such as CT or MRI, or only provide localized qualitative information such as flexible endoscopy. Long range optical coherence tomography (OCT) has been used to visualize the human airway in vivo, however the limited imaging range has prevented full delineation of the various shapes and sizes of the lumen. We present a new long range OCT system that integrates high speed imaging with a real-time position tracker to allow for the acquisition of an accurate 3D anatomical structure in vivo. The new system can achieve an imaging range of 30 mm at a frame rate of 200 Hz. The system is capable of generating a rapid and complete visualization and quantification of the airway, which can then be used in computational simulations to determine obstruction sites.

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Section: Discussionmentioning

confidence: 99%

Anatomically correct visualization of the human upper airway using a high-speed long range optical coherence tomography system with an integrated positioning sensor

Jing

Chou

et al. 2016

Sci Rep

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“…As dental professionals transition to three-dimensional imaging, further studies may be done utilizing three-dimensional landmarks and measurements to provide more accurate predictors of the outcome of oral appliance treatment. Recent studies utilizing magnetic resonance imaging, computed tomography, and cone-beam computed tomography have all provided valuable airway volumetric data that are not provided by two-dimensional cephalograms alone 41–43. Future research using volumetric airway imaging may provide valuable insights into predicting individual responses to oral appliance therapy.…”

Section: Prediction Of Oral Appliance Treatment Outcomesmentioning

confidence: 99%

Innovative treatments for adults with obstructive sleep apnea

Weaver¹,

Calik²,

Farabi³

et al. 2014

NSS

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Obstructive sleep apnea (OSA) affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical stimulation of the upper airway muscles. No drugs have been approved to treat OSA, but potential drug therapies have centered on increasing ventilatory drive, altering the arousal threshold, modifying loop gain (a dimensionless value quantifying the stability of the ventilatory control system), or preventing airway collapse by affecting the surface tension. An emerging approach is the application of cannabinoids to increase upper airway tone.

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“…With its low radiation dose relative to multi-detector CT, cone beam CT (CBCT) provides insights to the anatomical anomalies found along the upper airway and craniofacial disproportions and has been used to measure anatomic airway changes with surgical and dental appliance treatment for adult SDB/OSA [8]. However, significant drawbacks were related to the questionable accuracy of the reconstructed upper airway 3D models, lack of clinical correlation with CBCT measurements, and the use of global non-specific airway measure such as volume, linear, and cross-sectional area measurements [8, 9].…”

Section: Introductionmentioning

confidence: 99%

“…However, significant drawbacks were related to the questionable accuracy of the reconstructed upper airway 3D models, lack of clinical correlation with CBCT measurements, and the use of global non-specific airway measure such as volume, linear, and cross-sectional area measurements [8, 9]. Unlike global measures, point-based analysis with color mapping better explained differences in 3D upper airway models generated from CBCT [10].…”

Section: Introductionmentioning

confidence: 99%

Using cone beam CT to assess the upper airway after surgery in children with sleep disordered breathing symptoms and maxillary-mandibular disproportions: a clinical pilot

Alsufyani

Noga

Witmans

et al. 2017

J of Otolaryngol - Head & Neck Surg

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BackgroundThe surgical excision of anatomic obstructions such as adenoids, palatine or lingual tonsils are commonly performed in children with sleep disordered breathing (SDB). Imaging studies measuring airway changes post-surgery in the SDB pediatric population are scarce, rarely addresses the nasal cavity, and are based on global measures (e.g. volume) that do not represent the complexity of the upper airway anatomy. The purpose of this pilot is to test the feasibility in using cone beam CT (CBCT) to analyze the nasal and pharyngeal airway space post-surgery using meaningful methods of analyses, and correlating imaging findings with clinical outcomes in children with SDB symptoms and maxillary-mandibular disproportion.MethodsTwelve non-syndromic children with SDB symptoms and jaw disproportions were evaluated by interdisciplinary airway team before and after upper airway surgery. CBCT and OSA-18 quality of life questionnaire pre and post-operatively were completed. Conventional and new airway variables were measured based on 3D models of the upper airways and correlated with OSA-18. Conventional measures include volume, surface area, and cross-sectional area. New airway measures include constriction and patency; point-based analyses.ResultsEight females and four males were 8.8 ± 2 years with mean BMI of 18.7 ± 3. OSA-18 improved, median (lower quartile-upper quartile) from 64.2 (54.7–79.5) to 37.6 (28.7–43) postoperatively, p < 0.001. The median of all airway measures improved however with very wide range. Subjects with the smallest amounts of constriction relief and/or gain in airway patency presented with least improvement in OSA-18. New airway measures show strong correlation with changes in OSA-18 (ρ = 0.44 to 0.71) whereas conventional measures showed very weak correlation (ρ = −0.04 to 0.37).ConclusionsUsing point-based analyses, new airway measures better explained changes in clinical symptoms compared to conventional measures. Airway patency gained by at least 150% and constriction relief by at least 15% showed marked improvement in OSA-18 by 40–55%, after surgery in the tested cohort.Electronic supplementary materialThe online version of this article (doi:10.1186/s40463-017-0204-4) contains supplementary material, which is available to authorized users.

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CBCT assessment of upper airway changes and treatment outcomes of obstructive sleep apnoea: a systematic review

Cited by 80 publications

References 38 publications

Anatomically correct visualization of the human upper airway using a high-speed long range optical coherence tomography system with an integrated positioning sensor

Anatomically correct visualization of the human upper airway using a high-speed long range optical coherence tomography system with an integrated positioning sensor

Innovative treatments for adults with obstructive sleep apnea

Using cone beam CT to assess the upper airway after surgery in children with sleep disordered breathing symptoms and maxillary-mandibular disproportions: a clinical pilot

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