Objective: To investigate changes in the upper airway and its surrounding soft tissue and to characterize the extent and severity of upper airway obstruction in 136 obstructive sleep apnea/hypopnea syndrome (OSAHS) patients who were awake. Methods: OSAHS patients and healthy controls were evaluated by fiber-optic nasolaryngoscopy and MRI. The cross-sectional area and pharyngeal wall thickness of the retropalatal, retroglossal and epiglottic region were determined. Results: Ninety-five percent of the mild OSAHS subjects had single-plane obstruction (vs. severe OSAHS, p < 0.05), 5.0% of the mild OSAHS subjects had two-plane obstruction (p < 0.05) and none of them had three-plane obstruction (p < 0.05). The cross-sectional area of the retropalatal, retroglossal and epiglottic region progressively declined as the severity of OSAHS increased (severe OSAHS vs. controls, p < 0.05). The lateral pharyngeal wall was significantly thicker in OSAHS subjects than in healthy controls (p < 0.05). The cross-sectional area of the soft palate in moderate and severe OSAHS subjects was markedly larger than that of the healthy controls (p < 0.05) and positively correlated with the apnea/hypopnea index (p < 0.05). Conclusion: Moderate and severe OSAHS patients exhibit multi-plane obstruction of the upper airway, particularly in the retropalatal and retroglossal region. The severity of OSAHS negatively correlates with the thickness, length and cross-sectional area size of the soft palate.

Keywords:
Obstructive sleep apnea/hypopnea syndrome, BMI, Polysomnography, Epworth sleepiness scale, Palatopharyngeal muscle
1.
Guideline for the diagnosis and surgical treatment of obstructive sleep apnea hypopnea syndrome (in Chinese). Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2009;44:295-296.
2.
Sleep-related breathing disorders in adults: recommendations for syndrome of definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-689.
3.
Gould GA, Whyte KF, Rhind GB, Airlie MA, Catterall JR, Shapiro CM, Douglas NJ: The sleep hypopnea syndrome. Am Rev Respir Dis 1988;137:895-898.
4.
Johns MW: A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-545.
5.
Sher AE, Thorpy MJ, Shprintzen RJ, Spielman AJ, Burack B, McGregor PA: Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty. Laryngoscope 1985;95:1483-1487.
6.
Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI: Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 1995;152:1673-1689.
7.
Haponik EF, Smith PL, Bohlman ME, Allen RP, Goldman SM, Bleecker ER: Computerized tomography in obstructive sleep apnea. Correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis 1983;127:221-226.
8.
Lin HC, Friedman M, Chang HW, Gurpinar B: The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope 2008;118:902-908.
9.
Winter WC, Gampper T, Gay SB, Suratt PM: Enlargement of the lateral pharyngeal fat pad space in pigs increases upper airway resistance. J Appl Physiol 1995;79:726-731.
10.
Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI: Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 1995;152:1673-1689.
11.
Lin ZH, Zhang HL, Wang YC, Li CF, Bai ZX: MRI observation on upper airway of patients with obstructive sleep apnea syndrome (in Chinese). Chin J Otorhinolaryngol 2000;35:51-54.
12.
Friedman M, Ibrahim H, Bass L: Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 2002;127:13-21.
© 2014 S. Karger AG, Basel
2014
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