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Moderate-to-severe obstructive sleep apnea syndrome is associated with altered tongue motion during wakefulness

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Abstract

Purpose

Impairment of genioglossus control is a frequent “non-anatomical” cause of obstructive sleep apnea syndrome (OSAS) in non- or mildly obese patients. Although wake-related compensatory mechanisms prevent the occurrence of obstructive events, the genioglossus control is often impaired during wakefulness. We hypothesized that the lingual motion would be altered during wakefulness in this population in patients with moderate-to-severe OSAS.

Methods

We included non- or mildly obese participants with suspected OSAS. They underwent a Bucco-Linguo-Facial Motor Skills assessment using the MBLF (“Motricité Bucco-Linguo-Faciale”), which includes an evaluation of 13 movements of the tongue. This was followed by a night-attended polysomnography. We compared patients with moderate-to-severe OSAS (apnea–hypopnea index (AHI) ≥ 15/h; n = 15) to patients without or with mild OSAS (AHI < 15/h; n = 24).

Results

MBLF total and “tongue” sub-scores were lower in patients with moderate-to-severe OSAS: total z-score − 0.78 [− 1.31; 0.103] versus 0.20 [− 0.26; 0.31], p = 0.0011; “tongue” z-sub-score (− 0.63 [− 1.83; 0.41] versus 0.35 [0.26; 0.48], p = 0.014). There was a significant age-adjusted correlation between the “tongue” sub-score and AHI. The logistic regression model for the prediction of moderate-to-severe OSAS gave area under the curve ratio of 88.2% for MBLF score plus age.

Conclusions

Myofunctional activity of the tongue is impaired during wakefulness in non- or mildly obese patients with moderate-to-severe OSAS. This study supports the lingual myofunctional assessment using the MBLF in screening of moderate-to-severe OSAS. This simple tool could help clinicians to select patients with suspected moderate-to-severe OSAS for polysomnography.

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Data availability statement

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AHI:

Apnea–hypopnea index

AUCs:

Area under the receiver-operating characteristic (ROC) curve

BMI:

Body mass index

ESS:

Epworth Sleepiness Scale

HNR:

Harmonic-to-noise ratio

MBLF:

Motricité Bucco-Linguo-Faciale (oral-linguo-facial motor skills)

MPT:

Maximum phonation time

OSAS:

Obstructive sleep apnea syndrome

PSG:

Polysomnography

PSQI:

Pittsburgh Sleep Quality Index

VHI:

Voice Handicap Index

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Acknowledgements

The authors are grateful to Mrs Frédérique Wilson, for her help with English style.

Funding

This research did not receive any financial support.

Author information

Authors and Affiliations

  1. UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France

    Valérie Attali, Isabelle Rivals, Thomas Similowski & Peggy Gatignol

  2. Département R3S, Service des Pathologies du Sommeil, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France

    Valérie Attali & Isabelle Arnulf

  3. Département d’Orthophonie, Faculté de Médecine UFR 967, Sorbonne Université, 75013, Paris, France

    Mathilde Weber & Peggy Gatignol

  4. Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France

    Isabelle Rivals

  5. Département R3S, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France

    Thomas Similowski

  6. Institut du Cerveau, Paris Brain Institute-ICM, INSERM, CNRS, Sorbonne Université, 75013, Paris, France

    Isabelle Arnulf

  7. Service d’Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France

    Peggy Gatignol

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by VA, MW, IR, and PG. The first draft of the manuscript was written by VA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Valérie Attali.

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Conflict of interest

Peggy Gatignol is co-author of the MBLF tool. As such, she participated in the development of the tool and its standardization. Dr. Arnulf had no link of interest related to the study. Outside the study, she took part in an advisory board of IDORSIA in 2020. Dr. Attali had had no link of interest related to the study. Outside the study, she took part in an advisory board of BIOPROJET in 2021. Dr. Similowski reports personal fees for consulting and teaching activities from ADEP Assistance, AstraZeneca France, Chiesi France, KPL consulting, Lungpacer Inc., OSO-AI, TEVA France, Vitalaire, all outside the submitted work. The others authors declare no conflict of interest with respect to the research.

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This article is part of the Topical Collection on sleep apnea syndrome. Guest editors: Manuele Casale and Rinaldi Vittorio.

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Attali, V., Weber, M., Rivals, I. et al. Moderate-to-severe obstructive sleep apnea syndrome is associated with altered tongue motion during wakefulness. Eur Arch Otorhinolaryngol 280, 2551–2560 (2023). https://doi.org/10.1007/s00405-023-07854-9

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