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

Year 2018, , 161 - 169, 18.12.2018

Suat Avcı , Aynur Yılmaz Avcı

https://doi.org/10.32448/entupdates.508092

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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