Upper Airway Patency and Nocturnal Desaturation in Habitual Snoring and Obstructive Sleep Apnea: Pathogenesis of Sleep-Related Breathing Disorders

Abstract

Sixty patients, 53 men and 7 women, referred for excessive snoring or suspected sleep apnea syndrome were analyzed by polysomnography, Mueller maneuver, cephalometric roentgenography, and pulmonary function testing, to evaluate the contribution of static and dynamic upper airway obstruction in the pathogenesis of sleep-related breathing disorders and OSAS. Desaturation index and maximal desaturation were used in the analysis as indicators of severity of sleep-related breathing disorders. Body Mass Index, increased collapsibility at the base of the tongue by the Mueller maneuver, increased distance between hyoid and mandibular plane, and increased soft palate diameters by cephalometry as well as a decreased peak inspiratory flow by pulmonary function testing were found to be related to increased oxygen desaturation parameters. In a multivariate analysis the significant obstruction parameters could explain only 37% of the variability of maximum desaturation and 31% of the variability of desaturation index, 63 and 69%, respectively, must therefore be explained by other mechanisms. We conclude that instability of respiratory and muscular control, possibly enhanced by sleep-phase-related changes, is more important in the pathogenesis of sleep-related breathing disorders than pure anatomic narrowing of the airway.

The upper airway in sleep‐disordered breathing: A clinical prediction model

“…Two‐thirds of the influencing factors are either not known or not detected and documented appropriately. The data of the presented study confirm previous findings of Boot et al17 who concluded that only one‐third of nocturnal blood‐oxygen desaturation can be explained by clinical findings. Instabilities of muscular or pulmonary regulatory mechanisms, not detected by clinical examination, could contribute to an increased collapsibility of the upper airway in OSAS patients.…”

Day–night Differences in Oxygen Saturation and the Frequency of Desaturations in the First 24 Hours in Patients With Acute Stroke

“…Although sleep apnea and nocturnal oxygen desaturations have been linked with snoring in the general population, several studies have not found such a link in patients with stroke. [24][25][26][27] There was also no link between snoring status and desaturations in our study population.…”

“…The median (range) respiratory rate was 20 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) breaths/min during the day and 18 breaths/min at night (P Ͻ .01, Wilcoxon test). There was a strong positive correlation between daytime and nighttime respiratory rates (Spearman's r ϭ 0.78, P Ͻ .001).…”

Myotonometry demonstrates changes of lingual musculature in obstructive sleep apnoea

“…The biomechanical properties of the tongue muscles may depend on BMIs. Boot et al [1] found that BMI increased collapsibility at the base of the tongue by the Mueller manoeuvre, which is associated with increased oxygen desaturation parameters in patients with sleep apnoea [1]. Also unproven is the hypothesis that weight gain results in an increased muscle mass of the lateral pharyngeal walls and the soft palate in patients with OSA [16].…”