Different Craniofacial Characteristics Predict Upper Airway Collapsibility in Japanese-Brazilian and White Men

Schorr, Fabíola; Kayamori, Fabiane; Hirata, Raquel Pastréllo; Danzi-Soares, Naury J.; Gebrim, Eloísa Maria Mello Santiago; Moriya, Henrique Takachi; Malhotra, Atul; Lorenzi-Filho, Geraldo; Genta, Pedro Rodrigues

doi:10.1378/chest.15-0638

Cited by 58 publications

(69 citation statements)

References 37 publications

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“…1 The imbalance between bony enclosure and soft tissue has been considered a major determinant of the anatomical predisposition to OSA. 2,3 We showed that whites had a greater anatomical imbalance than Japanese-Brazilians and that Pcrit was associated with anatomical imbalance among whites only. 1 Different methods have been used to describe the anatomical imbalance in OSA.…”

Section: Measurement Of Mandibular Volume For Anatomical Imbalance Inmentioning

confidence: 77%

Measurement of Mandibular Volume for Anatomical Imbalance in OSA

Lee

2016

Chest

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Section: Measurement Of Mandibular Volume For Anatomical Imbalance Inmentioning

confidence: 77%

Measurement of Mandibular Volume for Anatomical Imbalance in OSA

Lee

2016

Chest

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“…5,6 Pcrit is a well-established method that is able to predict the anatomical component of OSA. [9][10][11][12] However, Pcrit is a laborious examination performed during sleep that requires experienced investigators and is only used for research purposes. In contrast, NEP is a simple noninvasive technique performed while awake, does not require patient collaboration, and can be determined in approximately 10 min.…”

Section: Discussionmentioning

confidence: 99%

“…Pcrit is associated with anatomic features such as pharyngeal length and tongue volume. [8][9][10][11][12] However, Pcrit is a laborious method that requires a complex setup and experienced investigators capable of recognizing sleep stages and flow limitation during CPAP application.…”

Section: Introductionmentioning

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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“…For comparison, we selected the right masseter muscle as a control and measured its attenuation values using a 1 cm 2 ROI. We also obtained midline sagittal reconstructions to identify the following landmarks: hyoid bone, mandibular plane and base of epiglottis, as described previously [6,10,11]. The mandibular plane to hyoid distance (MPH) was determined as the distance between the inferior margins of the mandible to the superior margin of hyoid on the sagittal plane.…”

Section: Methodsmentioning

confidence: 99%

Fat accumulation in the tongue is associated with male gender, abnormal upper airway patency and whole-body adiposity

et al. 2016

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Objective To examine associations between tongue adiposity with upper airway measures, whole-body adiposity and gender. We hypothesized that increased tongue adiposity is higher in males and positively associated with abnormal upper airway measures and whole-body adiposity. Methods We studied subjects who underwent whole-body positron emission tomography/computed tomography to obtain tongue attenuation (TA) values and cross-sectional area, pharyngeal length (PL) and mandibular-hyoid distance (MPH), as well as abdominal circumference, abdominal subcutaneous and visceral (VAT) adipose tissue areas, neck circumference (NC) and neck adipose tissue area. Metabolic syndrome was determined from available clinical and laboratory data. Results We identified 206 patients (104 females, 102 males) with mean age 56±17y and mean body mass index (BMI) 28±6kg/m2 (range 16–47kg/m2). Males had lower TA values (P=0.0002) and higher upper airway measures (P< 0.0001) independent of age and BMI (P<0.001). In all subjects, TA was negatively associated with upper airway measures (P<0.001). TA was negatively associated with body composition parameters (all P<0.0001), most notably with VAT (r=−0.53) and NC (r=−0.47). TA values were lower in subjects with metabolic syndrome (P<0.0001). Conclusion Increased tongue adiposity is influenced by gender and is associated with abnormal upper airway patency and body composition parameters.

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Different Craniofacial Characteristics Predict Upper Airway Collapsibility in Japanese-Brazilian and White Men

Cited by 58 publications

References 37 publications

Measurement of Mandibular Volume for Anatomical Imbalance in OSA

Measurement of Mandibular Volume for Anatomical Imbalance in OSA

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

Fat accumulation in the tongue is associated with male gender, abnormal upper airway patency and whole-body adiposity

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