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Sleep and Breathing

, Volume 14, Issue 4, pp 353–358 | Cite as

Soft palate length and upper airway relationship in OSA and non-OSA subjects

  • Yuko Shigeta
  • Takumi Ogawa
  • Ikawa Tomoko
  • Glenn T. Clark
  • Reyes Enciso
Original Article

Abstract

Background

The narrowest area of the airway between the posterior nasal opening and the epiglottis is usually located in the retro palatal area. Many consider this the most likely site of airway obstruction during an obstructive sleep apnea (OSA) event. The aim of this study was to investigate the differences in soft palate and airway length between OSA and non-OSA patients.

Methods

In this study, we analyzed the ratio of the soft palate and the upper airway length in 45 consecutive patients. Twenty-five had an Apnea–Hypoapnea Index of more than five events per hour and were classified in the OSA group (male, 19; female, 6). These patients were compared with 20 normal controls (male, 12; female, 8). Controls who complained of snoring did have sleep studies (n = 5). The other fifteen controls were clinically asymptomatic and did not have sleep studies. Medical computed tomography scans were taken to determine the length of the upper airway and the soft palate length measured in the midsagittal image.

Results

Soft palate length was significantly larger in OSA patients compared to controls (p = 0.009), and in men compared to women (p = 0.002). However, there were no differences in airway length. The soft palate length, as a percent of oropharyngeal airway length, was significantly larger in OSA patients compared to controls (p = <0.0001) and in men compared to women (p = 0.02). Soft palate length increases significantly with age by 0.3 mm per year in males (after adjustment for body mass index (BMI) and OSA). Soft palate length as a percent of airway length is larger in OSA patients and increases significantly with BMI in males only after adjusting for age.

Conclusion

In this study, OSA patients had a longer soft palate in proportion to their oropharyngeal airway compared to controls as well as men compared to women. This proportion could be used for identifying patients at risk for OSA in combination with age.

Keywords

Soft palate length Oropharyngeal airway Obstructive sleep apnea Computerized tomography 

Notes

Acknowledgments/funding

Dr. Enciso was partially supported by the National Institute of Dental Craniofacial Research grant number 5 K25 DE016391. Dr. Ogawa was partially supported by “High-Tech Research Center” Project for Private Universities and grant number 18390501: matching fund subsidy from the Ministry of Education, Culture, Sports, Science and Technology, Japan. The authors have no conflict of interests.

References

  1. 1.
    Johnston CD, Richardson A (1999) Cephalometric changes in adult pharyngeal morphology. Eur J Orthod 21:357–362CrossRefPubMedGoogle Scholar
  2. 2.
    Hiremath AS, Hillman DR, James AL, Noffsinger WJ, Platt RR, Singer SL (1998) Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth 80:606–611PubMedGoogle Scholar
  3. 3.
    Nuckton TJ, Glidden DV, Browner WS, Claman DM (2006) Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep 29:903–908PubMedGoogle Scholar
  4. 4.
    Rodenstein DO, Dooms G, Thomas Y, Liistro G, Stanescu DC, Culee C, Aubert-Tulkens G (1990) Pharyngeal shape and dimension in healthy subjects, snorer and patients with obstructive sleep apnea. Thorax 45:722–727CrossRefPubMedGoogle Scholar
  5. 5.
    Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI (1995) Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Am J Respir Crit Care Med 152:1673–1689PubMedGoogle Scholar
  6. 6.
    Yu X, Fujimoto K, Urushibata K, Matsuzawa Y, Kubo K (2003) Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome. Chest 124:212–218CrossRefPubMedGoogle Scholar
  7. 7.
    Ciscar MA, Juan G, Martinez V, Ramon M, Lloret T, Minguez J, Armengot M, Marin J, Basterra J (2001) Magnetic resonance imaging of the pharynx in OSA patients and healthy subjects. Eur Resp J 17:79–86CrossRefGoogle Scholar
  8. 8.
    Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S (1999) Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J 13:403–410CrossRefPubMedGoogle Scholar
  9. 9.
    Johal A, Conaghan C (2004) Maxillary morphology in obstructive sleep apnea: a cephalometric and model study. Angle Orthod 74:648–656PubMedGoogle Scholar
  10. 10.
    Namyslowski G, Scierski W, Zembala-Nozynska E, Nozynski J, Misiolek M (2005) Histopathologic changes of the soft palate in snoring and obstructive sleep apnea syndrome patients. Otolaryngo Pol 59:13–19Google Scholar
  11. 11.
    Malhotra A, Huang Y, Fogel R, Lazic S, Pillar G, Jakab M, Kikinis R, White D (2006) Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med 119(1):72.e9–14CrossRefPubMedGoogle Scholar
  12. 12.
    Cosentini T, Le Donne R, Mancini D, Colavita N (2004) Magnetic resonance imaging of the upper airway in obstructive sleep apnea. Radiol Med 108(4):404–416PubMedGoogle Scholar
  13. 13.
    Battagel JM, Johal A, Kotecha B (2000) Cephalometric comparison of subjects with snoring and obstruct sleep apnea. Eur J Orthod 22:353–365CrossRefPubMedGoogle Scholar
  14. 14.
    Lam B, Ooi CGC, Peh WCG, Lauder I, Tsang KWT, Wah-Kit L, Ip MSM (2004) Computed tomographic evaluation of the role of craniofacial and upper airway morphology in obstructive sleep apnea in Chinese. Respir Med 98(4):301–307CrossRefPubMedGoogle Scholar
  15. 15.
    Lowe AA, Ono T, Ferguson KA, Pae EK, Ryan CF, Fleetham JA (1996) Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 110(6):653–664CrossRefPubMedGoogle Scholar
  16. 16.
    Segal Y, Malhotra A, Pillar G (2008) Upper airway length may be associated with the severity of obstructive sleep apnea syndrome. Sleep Breath 12(4):311–316CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Yuko Shigeta
    • 1
    • 2
  • Takumi Ogawa
    • 2
  • Ikawa Tomoko
    • 2
  • Glenn T. Clark
    • 1
  • Reyes Enciso
    • 3
  1. 1.Orofacial Pain/Oral Medicine Center, Division of Diagnostic Sciences, School of DentistryUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Fixed Prosthodontic DentistrySchool of Dental Medicine, Tsurumi UniversityYokohamaJapan
  3. 3.Division of Craniofacial Sciences and Therapeutics, School of DentistryUniversity of Southern CaliforniaLos AngelesUSA

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