Obstructive Sleep Apnea Syndrome: Hooked Appearance of the Soft Palate in Awake Patients—Cephalometric and CT Findings

Objectives: To determine the prevalence of sleep apnea (SA) and SA syndrome (SAS) in patients with acromegaly and correlate SA with clinical, laboratory, and cephalometric parameters. Design and methods: Prospective and cross-sectional study of 24 patients with active acromegaly evaluated by clinical and laboratory (GH, IGF-I) parameters, polysomnography and magnetic resonance imaging (MRI) of the pharynx. Results: Out of 24 patients, 21 had SA (87.5%), of which 20 (95.3%) had the predominant obstructive type. Median age of these 21 patients was 54 years (range 23-75) and median estimated disease duration was 60 months (range 24-300). The frequency in SA patients of impaired glucose tolerance, diabetes mellitus (DM), and hypertension was 19, 33.3, and 71.4% respectively. Goiter was found in 10 patients (47.6%) and obesity in 18 (90%). Median GH level was 14 mg/l (1.4-198) and median %IGF-I (percentage above the upper limit of normal range of IGF-I) was 181% (K31.6 to 571.2). The prevalence of SAS was 52.4%. Apnea-hypopnea index (AHI) correlated significantly with age, waist circumference, body mass index, and hypopharynx area. The AHI was significantly higher in patients with hypertension and DM. Conclusions: The prevalence of SA and SAS in acromegaly was similar to the one previously described in other series. Age was a significant risk factor, and hypertension and DM were significantly associated complications of SA. Obesity was also significantly related to SA, as a risk factor, a complication or both. Overall, cephalometric parameters by MRI did not correlate with SA.European Journal of Endocrinology 158 459-465

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“…We found that 63.1% of the patients (12/19) had enlarged soft palates (reference value: 34G6 mm) (15).…”

Section: Clinical and Laboratory Patients' Profilementioning

confidence: 70%

“…1). There are no established normal ranges for all these measurements, except for the length of the soft palate, for which the reference value is 34G6 mm (15).…”

Section: Cephalometric Measurementsmentioning

confidence: 99%

Prevalence of sleep apnea and metabolic abnormalities in patients with acromegaly and analysis of cephalometric parameters by magnetic resonance imaging.

Haute

Taboada

Corrêa

et al. 2008

European Journal of Endocrinology

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“…There was no cleft defect. Imaging evaluation of the morphological airway changes has been performed in patients with OSA using techniques such as cephalometric radiography, CT, and magnetic resonance imaging [9][10][11]. CT scans though can create 3D images, exposes the child to ionizing radiation naturally experienced during approximately 8 months.…”

Section: Discussionmentioning

confidence: 99%

Distraction Osteogenesis for Management of Severe OSA in Pierre Robin Sequence: An Approach to Elude Tracheostomy in Infants

Sahoo¹,

Roy²,

Dalal

et al. 2016

J. Maxillofac. Oral Surg.

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Background Severe obstructive sleep apnoea (OSA) is a life threatening condition associated with Pierre Robin sequence (PRS) due to mandibular micrognathia and glossoptosis. Often these patients require tracheostomy at an early age which has high morbidity. Distraction osteogenesis (DO) is an accepted method of treatment for patients with hypoplastic mandible to achieve mandibular lengthening without need for a bone graft. It has also been used in respiratory distressed neonates and infants to avoid tracheostomy. Case report An eight month old baby, a diagnosed case of PRS with severe OSA and recurrent episodes of aspiration pneumonia and on nasogastric tube feeding since birth was referred to us for evaluation and possibility of therapeutic augmentation of the mandible by DO. After a thorough clinico-radiological assessment the child was operated for bilateral extraoral placement of horizontal corpus distractor. A total distraction of 12 mm was carried out and consolidation of callus was monitored by USG. Postoperatively the patient was followed up for 12 months. Presently she has normal respiratory and feeding function without any episode of aspiration pneumonia. Conclusion Mandibular corpus DO is a safe and effective technique that can be applied to predictably relieve severe upper airway obstruction in selected PRS cases. In order to avoid the limitations of alternative surgical procedures and the tracheostomy-associated morbidity, DO should be considered among the routine treatment modalities.

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“…A região RL se estende da ponta da úvula à base da epiglote (11) . Muitos estudos têm sido realizados na tentativa de demonstrar que o tamanho e a morfologia das estruturas que compõem as vias aéreas superiores e as dimensões das estruturas a ela adjacentes influenciam o calibre da via aérea superior dos pacientes com SAOS (5,6,(11)(12)(13)18,29,(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) .…”

Section: Anatomia Das Vias Aéreas Superioresunclassified

“…Nos últimos anos, com o advento da TC multislice e com a maior disponibilidade destes aparelhos, a TC tem sido utilizada como método auxiliar no diagnóstico da SAOS, e vários estudos têm sido realizados nestes pacientes, o que vem facilitando o entendimento da patogênese desta entidade (24,33,39,41,44) .…”

Section: Tomografia Computadorizadaunclassified

Avaliação da faringe de pacientes portadores de apneia obstrutiva do sono, por meio da tomografia computadorizada multislice obtida em vigília e durante o sono

Passos¹

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Obstructive Sleep Apnea Syndrome: Hooked Appearance of the Soft Palate in Awake Patients—Cephalometric and CT Findings

Abstract: Cephalometric radiography and CT can demonstrate hooking of the soft palate in awake patients. This finding indicates a high risk for OSAS.

Cited by 39 publications

References 34 publications

Prevalence of sleep apnea and metabolic abnormalities in patients with acromegaly and analysis of cephalometric parameters by magnetic resonance imaging.

Prevalence of sleep apnea and metabolic abnormalities in patients with acromegaly and analysis of cephalometric parameters by magnetic resonance imaging.

Distraction Osteogenesis for Management of Severe OSA in Pierre Robin Sequence: An Approach to Elude Tracheostomy in Infants

Avaliação da faringe de pacientes portadores de apneia obstrutiva do sono, por meio da tomografia computadorizada multislice obtida em vigília e durante o sono

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