The relationship between passive rhinomanometry measurements in sitting and supine position and obstructive sleep apnea syndrome

Abstract

Objectives: This study aims to investigate the possible relationship between passive rhinomanometry measurements in sitting and supine position and obstructive sleep apnea syndrome. Patients and Methods: Between January 2011 and December 2013, 88 male patients mean age 46.8 years; range 18 to 79 years underwent passive rhinomanometry in sitting and supine position following history, physical examination and fiberoptic endoscopic examination. 1.5 lt/sn air flow was pumped into the nose of each patient via a silicone nasal mask. Meanwhile, flow and pressure values were measured. Results: There was no correlation between the resistance values and apnea hypopnea index AHI scores and polysomnography and physical examination parameters p>0.05 . The differential resistance was correlated with AHI r=0.325, p<0.05 , body mass index r=0.324, p<0.05 , neck circumference r=0.421, p<0.01 , waist circumference r=0.444, p<0.01 , modified Mallampati score r=0.356, p<0.05 , and retropalatal grade r=0.438, p<0.01 . Conclusion: The correlation between the differential resistance and physical examination parameters and AHI scores support the hypothesis that position-related retropalatal segment alterations can be measured by passive rhinomanometry while awake.

Keywords

• Obstructive sleep apnea, passive rhinomanometry, retropalatal segment resistance

Oturur ve sırtüstü pozisyonda pasif rinomanometri ölçümleri ve tıkayıcı uyku apne sendromu ile ilişkisi

Abstract

Amaç: Bu çalışmada oturur ve sırtüstü pozisyonda pasif rinomanometri ölçümleri ile tıkayıcı uyku apne sendromu arasındaki muhtemel ilişki araştırıldı.Hastalar ve Yöntemler: Ocak 2011 - Aralık 2013 tarihleri arasında 88 erkek hastaya ort. yaş 46.8 yıl; dağılım 18-79 yıl öykü, fizik muayene ve fiberoptik muayeneyi takiben oturur ve sırtüstü pozisyonda pasif rinomanometri uygulandı. Her hastanın burnuna silikon bir nazal maske aracılığı ile 1.5 lt/sn hava akımı verildi. Bu sırada oluşan akım ve basınç değerleri ölçüldü.Bulgular: Direnç değerleri ve apne hipopne indeksi AHİ skorları ile polisomnografi ve fizik muayene parametreleri arasında ilişki bulunmadı p>0.05 . Diferansiyel direnç ile AHİ r=0.325, p

Keywords

• Tıkayıcı uyku apnesi, pasif rinomanometri, retropalatal segment direnci

References

1. Ömür M, Elez F, Ömür M. Obstrüktif uyku-apne sendromunda cerrahi tedavi. In: Kaynak H, Ardıç S, editörler. Uyku Fizyolojisi ve Hastalıkları. İstanbul: Nobel Tıp Kitapevleri; 2010. s. 229-48.
2. Zonato AI, Bittencourt LR, Martinho FL, Jşnior JF, Gregório LC, Tufik S. Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome. Laryngoscope 2003;113:973-80.
3. Dreher A, de la Chaux R, Klemens C, Werner R, Baker F, Barthlen G, et al. Correlation between otorhinolaryngologic evaluation and severity of obstructive sleep apnea syndrome in snorers. Arch Otolaryngol Head Neck Surg 2005;131:95-8.
4. Barceló X, Mirapeix RM, Bugés J, Cobos A, Domingo C. Oropharyngeal examination to predict sleep apnea severity. Arch Otolaryngol Head Neck Surg 2011;137:990-6.
5. Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope 1999;109:1901-7.
6. Aurora RN, Casey KR, Kristo D, Auerbach S, Bista SR, Chowdhuri S, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 2010;33:1408-13.
7. Welch KC, Foster GD, Ritter CT, Wadden TA, Arens R, Maislin G, et al. A novel volumetric magnetic resonance imaging paradigm to study upper airway anatomy. Sleep 2002;25:532-42.
8. Abdullah VJ, Koutsourelakis I, Ravesloot MJL, Lip Yen Lee D, Ching Nam Ha S, van Hasselt CA, et al. Drug induced sleep endoscopy. In: Pang KP, Woodson BT, Rotenberg B, editors. Textbook of Advanced Surgical Technique in Snoring and Obstructive Sleep Apnea. 1st ed. USA: Plural Publishing; 2013. p. 44.

9. Vogt K, Jalowayski AA, Althaus W, Cao C, Han D, Hasse W, et al. 4-Phase-Rhinomanometry (4PR)-- basics and practice 2010. Rhinol Suppl 2010;21:1-50.
10. Andreoli TE, Cecil RL. Cecil Essentials of Medicine. 2nd ed. Philadelphia: Saunders; 1990. p. 830.
11. Verin E, Tardif C, Buffet X, Marie JP, Lacoume Y, Andrieu-Guitrancourt J, et al. Comparison between anatomy and resistance of upper airway in normal subjects, snorers and OSAS patients. Respir Physiol 2002;129:335-43.
12. Jordan AS, White DP. Pharyngeal motor control and the pathogenesis of obstructive sleep apnea. Respir Physiol Neurobiol 2008;160:1-7.
13. Clement PA. Committee report on standardization of rhinomanometry. Rhinology 1984;22:151-5.
14. Isono S. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology 2012;17:32-42.