The role of the external nasal measures of patients with sleep disordered breathing in determining disease severity

Yıl 2019, Cilt: 29 Sayı: 4, 178 - 186, 10.12.2019

Mustafa Avcu Mehmet Metin Tufan Ulcay Zeynel Abidin Erbesler

Öz

Objectives: In this study, we aimed to investigate the influence of nasal anthropometric measurements on severity of obstructive sleep apnea syndrome OSAS and to assess the correlation between nasal anthropometric measurements and severity of OSAS after excluding internal factors causing nasal obstruction. Patients and Methods: A total of 241 consecutive patients 181 males, 60 females; mean age 50.3±11.3 years; range, 18 to 65 years with daily sleepiness and/or snoring complaints between February 1st 2018 and December 15th 2018 were included in the study. All patients were divided into eight groups as obese and non-obese according to the disease severity and BMI values. Results: According to the obese and non-obese groups, none of the anthropometric measurements in the obese group were correlated with OSAS, while only nasal width r: 0.282, p=0.001 , nasal tip height r: 0.235, p=0.008 , and alar-pronasal distance r: 0.156, p=0.031 were found to be correlated in the non-obese patient groups. Linear regression analysis of variables which appeared to correlate with the OSAS severity revealed that no variables except for age and BMI significantly contributed to the OSAS severity in the obese group. For the non-obese group, in addition to age and BMI values, nasal width significantly contributed to the disease severity. Conclusion: Although there are many factors in the etiology of OSAS, no external nasal anatomic measurement, except for the nasal width, seems to be correlated with the disease severity.

Anahtar Kelimeler

External nasal anatomy, nasal anthropometry, obstructive sleep apnea

Kaynakça

• Guilleminault C, Eldridge FL, Dement WC. Insomnia with sleep apnea: a new syndrome. Science 1973;181:856-8.
• Huang JF, Chen GP, Wang BY, Xie HS, Zhao JM, Wu LH, et al. Assessment of Upper-Airway Configuration in Obstructive Sleep Apnea Syndrome With Computed Tomography Imaging During Müller Maneuver. Respir Care 2016;61:1651-8.
• Dubey A, Upadhyay S, Mathur S, Kant S, Singh BP, Makwana R. Comparative evaluation of craniofacial anthropometric measurements in Indian adult patients with and without obstructive sleep apnea: A pilot study. J Indian Prosthodont Soc 2015;15:331-6.
• Archontogeorgis K, Nena E, Papanas N, Steiropoulos P. Biomarkers to improve diagnosis and monitoring of obstructive sleep apnea syndrome: current status and future perspectives. Pulm Med 2014;2014:930535.
• Kurt OK, Yildiz N. The importance of laboratory parameters in patients with obstructive sleep apnea syndrome. Blood Coagul Fibrinolysis 2013;24:371-4.
• Erdim I, Erdur O, Oghan F, Mete F, Celik M. Blood count values and ratios for predicting sleep apnea in obese children. Int J Pediatr Otorhinolaryngol 2017;98:85-90.
• Oyama J, Nagatomo D, Yoshioka G, Yamasaki A, Kodama K, Sato M, et al. The relationship between neutrophil to lymphocyte ratio, endothelial function, and severity in patients with obstructive sleep apnea. J Cardiol 2016;67:295-302.
• Tokuda F, Sando Y, Matsui H, Koike H, Yokoyama T. Serum levels of adipocytokines, adiponectin and leptin, in patients with obstructive sleep apnea syndrome. Intern Med 2008;47:1843-9.
• Inonu Koseoglu H, Pazarli AC, Kanbay A, Demir O. Monocyte Count/HDL Cholesterol Ratio and Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome: A Multicenter Study. Clin Appl Thromb Hemost 2018;24:139-44.
• Bozkus F, Dikmen N, Demir LS. Gamma-glutamyl transferase activity as a predictive marker for severity of obstructive sleep apnea syndrome and concomitant hypertension. Clin Respir J 2018;12:1964-73.
• Mete T, Yalcin Y, Berker D, Ciftci B, Guven Firat S, Topaloglu O, et al. Relationship between obstructive sleep apnea syndrome and thyroid diseases. Endocrine 2013;44:723-8.
• Gambineri A, Pelusi C, Pasquali R. Testosterone levels in obese male patients with obstructive sleep apnea syndrome: relation to oxygen desaturation, body weight, fat distribution and the metabolic parameters. J Endocrinol Invest 2003;26:493-8.
• Petrone A, Mormile F, Bruni G, Quartieri M, Bonsignore MR, Marrone O. Abnormal thyroid hormones and non-thyroidal illness syndrome in obstructive sleep apnea, and effects of CPAP treatment. Sleep Med 2016;23:21-5.
• Hillman DR, Walsh JH, Maddison KJ, Platt PR, Schwartz AR, Eastwood PR. The effect of diaphragm contraction on upper airway collapsibility. J Appl Physiol 2013;115:337-45.
• Finkelstein Y, Wolf L, Nachmani A, Lipowezky U, Rub M, Shemer S, et al. Velopharyngeal anatomy in patients with obstructive sleep apnea versus normal subjects. J Oral Maxillofac Surg 2014;72:1350-72.
• Lee RW, Vasudavan S, Hui DS, Prvan T, Petocz P, Darendeliler MA, et al. Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep 2010;33:1075-80.
• Poirier J, George C, Rotenberg B. The effect of nasal surgery on nasal continuous positive airway pressure compliance. Laryngoscope 2014;124:317-9.
• Leitzen KP, Brietzke SE, Lindsay RW. Correlation between nasal anatomy and objective obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2014;150:325-31.
• Farkas LG, Katic MJ, Forrest CR, Alt KW, Bagic I, Baltadjiev G, et al. International anthropometric study of facial morphology in various ethnic groups/races. J Craniofac Surg 2005;16:615-46.
• Colish J, Walker JR, Elmayergi N, Almutairi S, Alharbi F, Lytwyn M, et al. Obstructive sleep apnea: effects of continuous positive airway pressure on cardiac remodeling as assessed by cardiac biomarkers, echocardiography, and cardiac MRI. Chest 2012;141:674-81.
• Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med 2010;11:441-6.
• De Vito A, Berrettini S, Carabelli A, Sellari-Franceschini S, Bonanni E, Gori S, et al. The importance of nasal resistance in obstructive sleep apnea syndrome: a study with positional rhinomanometry. Sleep Breath 2001;5:3-11.
• Sakat MS, Sütbeyaz Y, Yüceler Z, Kantarci M, Kilic K, Kurt S. Cephalometric measurements with multislice computed tomography in patients with obstructive sleep apnea syndrome. J Craniofac Surg 2016;27:82-6.
• Lyberg T, Krogstad O, Djupesland G. Cephalometric analysis in patients with obstructive sleep apnoea syndrome: II. Soft tissue morphology. J Laryngol Otol 1989;103:293-7.
• Tagaya M, Nakata S, Yasuma F, Noda A, Morinaga M, Yagi H, et al. Pathogenetic role of increased nasal resistance in obese patients with obstructive sleep apnea syndrome. Am J Rhinol Allergy 2010;24:51-4.
• Rizzi M, Onorato J, Andreoli A, Colombo S, Pecis M, Marchisio P, et al. Nasal resistances are useful in identifying children with severe obstructive sleep apnea before polysomnography. Int J Pediatr Otorhinolaryngol 2002;65:7-13.
• Masdeu MJ, Seelall V, Patel AV, Ayappa I, Rapoport DM. Awake measures of nasal resistance and upper airway resistance on CPAP during sleep. J Clin Sleep Med 2011;7:31-40.