Postural mechanisms that maintain airway adequacy in obstructive sleep apnea as determined by magnetic resonance imaging

Abstract

Objective: This magnetic resonance imaging (MRI) study explored associations between neutral head posture, size, and shape of the pharyngeal airway with obstructive sleep apnea (OSA) severity.

Methods: This was a retrospective, cross-sectional study of 90 men evaluated by overnight polysomnography and neck MRI. To explore the relationship between the neutral head posture, pharyngeal airway, and surrounding structures, MRI of 60 OSA patients and a reference sample of 30 mild OSA patients or simple snorers were evaluated. During MRI, subjects were in the supine position with their heads in a neutral position. Craniocervical extension (CCE) and epiglot angle, length of the root of the tongue, distance from the mandibular plane to the hyoid bone (MP-H distance), and pharyngeal airway diameter at seven levels were measured.

Results: Shape differences were more apparent at the caudal levels where the shapes were more oblique in OSA samples. The largest shape difference was at the level behind the tongue. After adjusting for body mass index and age, neutral head posture was correlated with OSA severity. CCE was correlated with an increase in the length of the root of the tongue, MP-H distance, epiglot angle, and the two most caudal airway areas.

Conclusions: Overall, increased length of the root of the tongue, MP-H distance, and epiglot angle are associated with CCE in OSA patients and resulted in a larger and more oblique airway at most caudal planes, which should be considered as an adaptive postural mechanism that can maintain airway adequacy in OSA patients.

Keywords

• Obstructive sleep apnea,magnetic resonance imaging,neutral head posture,pharyngeal airway

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