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

Yıl 2018, Cilt: 8 Sayı: 3, 161 - 169, 18.12.2018

Suat Avcı Aynur Yılmaz Avcı

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Prisant LM, Dillard TA, Blanchard AR. Obstructive sleep apnea syndrome. J Clin Hypertens. 2006;8:746-50.
• 2. Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976;27:465-84.
• 3. Ciscar MA, Juan G, Martínez V, Ramón M, Lloret T, Mínguez J, Armengot M, Marín J, Basterra J. Magnetic resonance imaging of the pharynx in OSA patients and healthy subjects. Eur Respir J. 2001;17(1):79-86.
• 4. Schwab RJ, Gefter WB, Hoffman EA, Gupta KB, Pack AI. Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing. Am Rev Respir Dis. 1993;148(5):1385- 400.
• 5. Suratt PM, Dee P, Atkinson RL, Armstrong P, Wilhoit SC. Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis. 1983;127:487-92.
• 6. Lenza MG (1), Lenza MM, Dalstra M, Melsen B, Cattaneo PM. An analy - sis of different approaches to the assessment of upper airway morphology: a CBCT study. Orthod Craniofac Res. 2010;13(2):96-105. doi:10.1111/ j.1601-6343.2010.01482.x.
• 7. Abbott MB, Donnelly LF, Dardzinski BJ, Poe SA, Chini BA, Amin RS. Obstructive sleep apnea: MR imaging volume segmentation analysis. Ra - diology. 2004;232:889-95.
• 8. Schwab RJ. Upper airway imaging. Clin Chest Med. 1998;19:33-54.
• 9. Di Carlo G (1), Polimeni A, Melsen B, Cattaneo PM. The relationship be - tween upper airways and craniofacial morphology studied in 3D. A CBCT study. Orthod Craniofac Res. 2015;18:1-11. doi: 10.1111/ocr.12053.
• 10. Solow B, Skov S, Ovesen J, Norup PW, Wildschiødtz G. Airway dimensions and head posture in obstructive sleep apnoea. Eur J Orthod. 1996;18:571-9.
• 11. Sonnesen L, Petersson A, Berg S, Svanholt P. Pharyngeal airway dimen - sions and head posture in obstructive sleep apnea patients with and without morphological deviations in the upper cervical spine. J Oral Maxillofac Res. 2017;30;8:e4. doi: 10.5037/jomr.2017.8304.
• 12. Ozbek MM, Miyamoto K, Lowe AA, Fleetham JA. Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults. Eur J Orthod. 1998;20:133-43.
• 13. Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, Westchester
• 14. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus References CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Ward SLD, Tangredi MM (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 8:597–619. https:// doi.org/10.5664/jcsm.2172
• 15. Ono T, Otsuka R, Kuroda T, Honda E, Sasaki T.J Dent Res. Effects of head and body position on two- and three-dimensional configurations of the up - per airway. 2000;79:1879-84.
• 16. Pirilä-Parkkinen K(1), Pirttiniemi P, Pääkkö E, Tolonen U, Nieminen P, Löppönen H. Pharyngeal airway in children with sleep-disordered breath - ing in relation to head posture. Sleep Breath. 2012;16:737-46. doi:10.1007/ s11325-011-0569-y.
• 17. Zhang W (1), Song X, Masumi SI, Tanaka T, Zhu Q. Effects of head and body positions on 2- and 3-dimensional configuration of the oropharynx with jaw protruded: A magnetic resonance imaging study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:778-84. doi:10.1016/j.tri - pleo.2011.02.019.
• 18. Gurani SF, Di Carlo G, Cattaneo PM, Thorn JJ, Pinholt EM. Effect of head and tongue posture on the pharyngeal airway dimensions and morphology in three-dimensional imaging: A systematic review. J Oral Maxillofac Res. 2016;31;7:e1. doi: 10.5037/jomr.2016.7101.
• 19. Solow B, Ovesen J, Nielsen PW, Wildschiødtz G, Tallgren A. Head posture in obstructive sleep apnoea. Eur J Orthod. 1993;15:107-14.
• 20. Tangugsorn V, Skatvedt O, Krogstad O, Lyberg T. Obstructive sleep ap - noea: a cephalometric study. Part I. Cervico-craniofacial skeletal morphol - ogy. Eur J Orthod. 1995;17:45-56.
• 21. Polo OJ, Tafti M, Fraga J, Porkka KV, Déjean Y, Billiard M. Why don’t all heavy snorers have obstructive sleep apnea? Am Rev Respir Dis. 1991;143:1288-93.
• 22. Koski K, Lähdemäki P. Adaptation of the mandible in children with ade - noids. Am J Orthod. 1975 Dec;68(6):660-5.
• 23. Ünlü M, İriz A, Doğan BA, Dinç ASK, Dursun E, Eryılmaz A , Acar A. Relationship between obesity with symptoms and findings of obstruc - tive sleep apnea syndrome. J Med Updates 2014;4:11-15 doi:10.2399/ jmu.2014001003
• 24. Safiruddin F, Vanderveken OM, de Vries N, Maurer JT, Lee K, Ni Q, Strohl KP (2015) Effect of upper-airway stimulation for obstructive sleep apnea on airway dimensions. Eur Respir J 45:129–138. https://doi. org/10.1183/09031936.000594