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Ultrasonography of the neck in patients with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Introduction

In resource-limited settings, obstructive sleep apnea (OSA) often goes undiagnosed as polysomnography (PSG) is expensive, time-consuming, and not readily available. Imaging studies of upper airway have been tried as alternatives to PSG to screen for OSA. However, racial differences in upper airway anatomy preclude generalizability of such studies. We sought to test the hypothesis that ultrasonography (USG), an inexpensive, readily available tool to study soft tissue structures of the upper airway, would have predictive value for OSA in South Asian people.

Methods

Adult patients with sleep-related complaints suspicious for OSA were taken for overnight PSG. After the PSG, consecutive patients with and without OSA were studied with submental ultrasonography to measure tongue base thickness (TBT) and lateral pharyngeal wall thickness (LPWT).

Results

Among 50 patients with OSA and 25 controls, mean age was 43.9 ± 11.4 years, and 39 were men. Patients with OSA had higher TBT (6.77 ± 0.63 cm vs 6.34 ± 0.54 cm, P value = 0.004) and higher LPWT (2.47 ± 0.60 cm vs 2.12 ± 0.26 cm, P value = 0.006) compared to patients without OSA. On multivariate analysis, TBT, LPWT, and neck circumference were identified as independent factors associated with OSA. These variables could identify patients with severe OSA with a sensitivity of 72% and a specificity of 76%.

Conclusion

Patients with OSA have higher tongue base thickness and lateral pharyngeal wall thickness proportionate to the severity of the disease, independent of BMI and neck circumference. These findings suggest that sub-mental ultrasonography may be useful to identify patients with severe OSA in resource-limited settings.

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Data availability

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

Abbreviations

USG:

Ultrasonography

MRI:

Magnetic resonance imaging

CT:

Computed tomography

OSA:

Obstructive sleep apnea

LPWT:

Lateral pharyngeal wall thickness

TBT:

Tongue base thickness

CPAP:

Continuous positive airway pressure

PSG:

Polysomnography

AHI:

Apnea/hypopnea index

NC:

Neck circumference

WC:

Waist circumference

References

  1. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr - PubMed n.d. https://pubmed.ncbi.nlm.nih.gov/11254524/ (accessed June 14, 2021).

  2. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis - The Lancet Respiratory Medicine n.d. https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(19)30198-5.pdf (accessed June 14, 2021).

  3. Shu C-C, Lee P, Lin J-W, Huang C-T, Chang Y-C, Yu C-J et al (2013) The use of sub-mental ultrasonography for identifying patients with severe obstructive sleep apnea. PLoS ONE 8:e62848. https://doi.org/10.1371/journal.pone.0062848

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mortimore IL, Marshall I, Wraith PK, Sellar RJ, Douglas NJ (1998) Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 157:280–283. https://doi.org/10.1164/ajrccm.157.1.9703018

    Article  CAS  PubMed  Google Scholar 

  5. Apolloni F, Fusetti S (2021) Does overweight affect the sagittal dimension of the posterior airway space in a non-OSAS population? A case control study. Clin Exp Dent Res 7:226–230. https://doi.org/10.1002/cre2.358

    Article  PubMed  Google Scholar 

  6. Bosi M, De Vito A, Gobbi R, Poletti V, Vicini C (2017) The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy. Eur Arch Otorhinolaryngol 274:1251–1261. https://doi.org/10.1007/s00405-016-4223-y

    Article  PubMed  Google Scholar 

  7. Gurgel M, Cevidanes L, Pereira R, Costa F, Ruellas A, Bianchi J et al (2021) Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes. Clin Oral Investig. https://doi.org/10.1007/s00784-021-04066-5

    Article  PubMed  PubMed Central  Google Scholar 

  8. Schwab RJ, Pasirstein M, Kaplan L, Pierson R, Mackley A, Hachadoorian R et al (2006) Family aggregation of upper airway soft tissue structures in normal subjects and patients with sleep apnea. Am J Respir Crit Care Med 173:453–463. https://doi.org/10.1164/rccm.200412-1736OC

    Article  PubMed  Google Scholar 

  9. Lowe AA, Fleetham JA, Adachi S, Ryan CF (1995) Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop 107:589–595. https://doi.org/10.1016/s0889-5406(95)70101-x

    Article  CAS  PubMed  Google Scholar 

  10. Barrera JE, Pau CY, Forest V-I, Holbrook AB, Popelka GR (2017) Anatomic measures of upper airway structures in obstructive sleep apnea. World J Otorhinolaryngol Head Neck Surg 3:85–91. https://doi.org/10.1016/j.wjorl.2017.05.002

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H et al (2014) Tongue fat and its relationship to obstructive sleep apnea. Sleep 37:1639–1648. https://doi.org/10.5665/sleep.4072

    Article  PubMed  PubMed Central  Google Scholar 

  12. Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R et al (2003) Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 168:522–530. https://doi.org/10.1164/rccm.200208-866OC

    Article  PubMed  Google Scholar 

  13. Schotland HM, Insko EK, Schwab RJ (1999) Quantitative magnetic resonance imaging demonstrates alterations of the lingual musculature in obstructive sleep apnea. Sleep 22:605–613. https://doi.org/10.1093/sleep/22.5.605

    Article  CAS  PubMed  Google Scholar 

  14. Chi L, Comyn F-L, Mitra N, Reilly MP, Wan F, Maislin G et al (2011) Identification of craniofacial risk factors for obstructive sleep apnoea using three-dimensional MRI. Eur Respir J 38:348–358. https://doi.org/10.1183/09031936.00119210

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Guo J, Gao X (2008) Zeng X [Correlation of upper airway and surrounding tissues with body mass index in non-apnea aged males]. Hua Xi Kou Qiang Yi Xue Za Zhi 26:44–49

    PubMed  Google Scholar 

  16. Okubo M, Suzuki M, Horiuchi A, Okabe S, Ikeda K, Higano S et al (2006) Morphologic analyses of mandible and upper airway soft tissue by MRI of patients with obstructive sleep apnea hypopnea syndrome. Sleep 29:909–915. https://doi.org/10.1093/sleep/29.7.909

    Article  PubMed  Google Scholar 

  17. Lahav Y, Rosenzweig E, Heyman Z, Doljansky J, Green A, Dagan Y (2009) Tongue base ultrasound: a diagnostic tool for predicting obstructive sleep apnea. Ann Otol Rhinol Laryngol 118:179–184. https://doi.org/10.1177/000348940911800304

    Article  PubMed  Google Scholar 

  18. Gupta A, Kumar R, Bhattacharya D, Thukral BB, Suri JC (2019) Craniofacial and upper airway profile assessment in North Indian patients with obstructive sleep apnea. Lung India 36:94–101. https://doi.org/10.4103/lungindia.lungindia_303_18

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ahn SH, Kim J, Min HJ, Chung HJ, Hong JM, Lee J-G et al (2015) Tongue volume influences lowest oxygen saturation but not apnea-hypopnea index in obstructive sleep apnea. PLoS ONE 10:e0135796. https://doi.org/10.1371/journal.pone.0135796

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Xu L, Keenan BT, Wiemken AS, Chi L, Staley B, Wang Z, et al. Differences in three-dimensional upper airway anatomy between Asian and European patients with obstructive sleep apnea. Sleep 2020;43. https://doi.org/10.1093/sleep/zsz273

  21. Schorr F, Kayamori F, Hirata RP, Danzi-Soares NJ, Gebrim EM, Moriya HT et al (2016) Different craniofacial characteristics predict upper airway collapsibility in Japanese-Brazilian and White men. Chest 149:737–746. https://doi.org/10.1378/chest.15-0638

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mello Junior CF de, Guimarães Filho HA, Gomes CA de B, Paiva CC de A. (2013) Radiological findings in patients with obstructive sleep apnea. J Bras Pneumol 39:98–101. https://doi.org/10.1590/s1806-37132013000100014

  23. Liu K-H, Chu WCW, To K-W, Ko FWS, Tong MWC, Chan JWS et al (2007) Sonographic measurement of lateral parapharyngeal wall thickness in patients with obstructive sleep apnea. Sleep 30:1503–1508. https://doi.org/10.1093/sleep/30.11.1503

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bilici S, Engin A, Ozgur Y, Ozlem Onerci C, Ahmet Gorkem Y, Aytul HY (2017) Submental ultrasonographic parameters among patients with obstructive sleep apnea. Otolaryngol Head Neck Surg 156:559–566. https://doi.org/10.1177/0194599816684109

    Article  PubMed  Google Scholar 

  25. Hussein SA, Kamel KM, Kaddah SZ, Abd El-Hamid EE, Shaban MM (2020) Role of ultrasonography in assessment of anatomic upper airway changes in patients with obstructive sleep apnea. Adv Respir Med 88:548–557. https://doi.org/10.5603/ARM.a2020.0187

    Article  PubMed  Google Scholar 

  26. Chen J-W, Chang C-H, Wang S-J, Chang Y-T, Huang C-C (2014) Submental ultrasound measurement of dynamic tongue base thickness in patients with obstructive sleep apnea. Ultrasound Med Biol 40:2590–2598. https://doi.org/10.1016/j.ultrasmedbio.2014.06.019

    Article  PubMed  Google Scholar 

  27. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events: Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine: Journal of Clinical Sleep Medicine: Vol 08, No 05 n.d. https://jcsm.aasm.org/doi/10.5664/jcsm.2172 (accessed January 17, 2022).

  28. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021. https://doi.org/10.1001/jama.284.23.3015

    Article  CAS  PubMed  Google Scholar 

  29. Oğretmenoğlu O, Süslü AE, Yücel OT, Onerci TM, Sahin A (2005) Body fat composition: a predictive factor for obstructive sleep apnea. Laryngoscope 115:1493–1498. https://doi.org/10.1097/01.mlg.0000172204.82314.c3

    Article  PubMed  Google Scholar 

  30. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384. https://doi.org/10.1056/NEJM200005113421901

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to acknowledge the support of the staff of Sleep Laboratory of Department of Medicine, and all the patients who consented for participating in this study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dr Atul Malhotra is funded by the US National Institutes of Health. Dr Atul Malhotra reports income related to medical education from Livanova, Equillium, Corvus, and Jazz. All other authors declare that they have no financial disclosures relevant to this article.

Author information

Authors and Affiliations

  1. Department of Medicine, All India Institute of Medical Sciences, New Delhi, India

    Bhavesh Mohan Lal, Animesh Ray, Gaurav Gupta & Sanjeev Sinha

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India

    Surabhi Vyas

  3. Critical Care and Sleep Medicine, UC San Diego School of Medicine, San Diego, CA, 92121, USA

    Atul Malhotra

  4. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

    Shivam Pandey & R. M. Pandey

  5. Department of Surgery, All India Institute of Medical Sciences, New Delhi, India

    Sandeep Aggarwal

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Bhavesh Mohan Lal and Surabhi Vyas. The first draft of the manuscript was written by Bhavesh Mohan Lal and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sanjeev Sinha.

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Ethics approval and consent to participate

Institute ethics committee approval was taken and the study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Conflict of interest

All authors declare that they have no conflict of interest. ResMed provided a philanthropic donation to UC San Diego School of Medicine, San Diego 92121, 358 CA, USA.

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Mohan Lal, B., Vyas, S., Malhotra, A. et al. Ultrasonography of the neck in patients with obstructive sleep apnea. Sleep Breath 27, 903–912 (2023). https://doi.org/10.1007/s11325-022-02682-3

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  • DOI: https://doi.org/10.1007/s11325-022-02682-3

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