Lateral pharyngeal wall collapse associated with hypoxemia in obstructive sleep apnea

Lan, Ming‐Chin; Liu, Stanley Yung‐Chuan; Lan, Ming‐Ying; Modi, Rahul; Capasso, Robson

doi:10.1002/lary.25126

Cited by 64 publications

(53 citation statements)

References 36 publications

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“…A number of studies involving DISE have indirectly reported their findings regarding epiglottis collapse in OSA patients (Table ). In a study published by Lan et al that correlated DISE findings with BMI and objective polysomnography variables in 64 patients with OSA, the authors noted that 12.5% and 26.6% of the patients had partial and complete anteroposterior epiglottis collapse, respectively . None had partial lateral epiglottis collapse and 3.1% had complete lateral collapse.…”

Section: Resultsmentioning

confidence: 97%

“…Epiglottis collapse during sleep has been estimated to occur in around 12% of adult patients with OSA . Based on a previous DISE study performed at our institution, epiglottis collapse may occur more frequently than previously reported in the literature . Currently, there is a lack of good understanding about the relationship between epiglottis collapse and OSA and what the most effective way to treat it is.…”

Section: Introductionmentioning

confidence: 94%

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Epiglottis collapse in adult obstructive sleep apnea: A systematic review

et al. 2015

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Section: Resultsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 94%

Epiglottis collapse in adult obstructive sleep apnea: A systematic review

et al. 2015

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“…Lan and colleagues studied 64 OSA patients with DISE and found that 30% exhibited complete collapse of the epiglottis. 20 Cavaliere et al found that 23% of the 66 patients studied had epiglottis involvement. 21 A similar prevalence of 24% was found in Ravesloot's study of 100 consecutive OSA patients.…”

Section: Discussionmentioning

confidence: 93%

Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse

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Sands

et al. 2017

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Objectives:In some patients, obstructive sleep apnea (OSA) can be resolved with improvement in pharyngeal patency by sleeping lateral rather than supine, possibly as gravitational effects on the tongue are relieved. Here we tested the hypothesis that the improvement in pharyngeal patency depends on the anatomical structure causing collapse, with patients with tongue-related obstruction and epiglottic collapse exhibiting preferential improvements. Methods: Twenty-four OSA patients underwent upper airway endoscopy during natural sleep to determine the pharyngeal structure associated with obstruction, with simultaneous recordings of airflow and pharyngeal pressure. Patients were grouped into three categories based on supine endoscopy: Tongue-related obstruction (posteriorly located tongue, N = 10), non-tongue related obstruction (collapse due to the palate or lateral walls, N = 8), and epiglottic collapse (N = 6). Improvement in pharyngeal obstruction was quantified using the change in peak inspiratory airflow and minute ventilation lateral versus supine. Results: Contrary to our hypothesis, patients with tongue-related obstruction showed no improvement in airflow, and the tongue remained posteriorly located while lateral. Patients without tongue involvement showed modest improvement in airflow (peak flow increased 0.07 L/s and ventilation increased 1.5 L/min). Epiglottic collapse was virtually abolished with lateral positioning and ventilation increased by 45% compared to supine position. Conclusions: Improvement in pharyngeal patency with sleeping position is structure specific, with profound improvements seen in patients with epiglottic collapse, modest effects in those without tongue involvement and-unexpectedly-no effect in those with tongue-related obstruction. Our data refute the notion that the tongue falls back into the airway during sleep via gravitational influences.

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“…In fact, some studies have reported that up to 30% of patients have complete collapse of the epiglottis[7]. Research also indicates that epiglottic collapse is difficult to treat with conventional therapies, such as oral appliances[9] and even CPAP[10, 11].…”

Section: Introductionmentioning

confidence: 99%

Predicting epiglottic collapse in patients with obstructive sleep apnoea

et al. 2017

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Objectives Obstructive sleep apnea (OSA) is characterized by pharyngeal obstruction occurring at different sites. Endoscopic studies reveal that epiglottic collapse renders patients at higher risk of failed oral appliance therapy or accentuated collapse on CPAP. Diagnosing epiglottic collapse currently requires invasive studies (imaging, endoscopy). Alternatively, we propose that epiglottic collapse can be detected from distinct airflow patterns it produces during sleep. Methods Twenty-three OSA patients underwent natural sleep endoscopy. A total of 1232 breaths were scored as epiglottic/non-epiglottic collapse. Several flow characteristics were determined from the flow signal (recorded simultaneously with endoscopy) and used to build a predictive model to distinguish epiglottic from non-epiglottic collapse. Additionally, ten OSA patients were studied to validate the pneumotachograph flow features using nasal pressure signals. Results Epiglottic collapse was characterized by a rapid fall(s) in the inspiratory flow, more variable inspiratory and expiratory flow, and reduced tidal volume. The cross-validated accuracy was 84%. Predictive features obtained from pneumotachograph flow and nasal pressure were strongly correlated. Conclusions This study demonstrates that epiglottic collapse can be identified from the airflow signal measured during a sleep study. This method may enable clinicians to use clinically-collected data to characterize underlying physiology and improve treatment decisions.

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Lateral pharyngeal wall collapse associated with hypoxemia in obstructive sleep apnea

Abstract: 4

Cited by 64 publications

References 36 publications

Epiglottis collapse in adult obstructive sleep apnea: A systematic review

Epiglottis collapse in adult obstructive sleep apnea: A systematic review

Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse

Predicting epiglottic collapse in patients with obstructive sleep apnoea

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