Skip to main content
SpringerLink
Log in

Evaluation of airway obstruction at soft palate level in male patients with obstructive sleep apnea/hypopnea syndrome: Dynamic 3-dimensional CT imaging of upper airway

  • Published:
Journal of Huazhong University of Science and Technology [Medical Sciences] Aims and scope Submit manuscript

Summary

This study examined the dynamic characteristics of upper airway collapse at soft palate level in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) by using dynamic 3-Dimensional (3-D) CT imaging. A total of 41 male patients who presented with 2 of the following symptoms, i.e., daytime sleepiness and fatigue, frequent snoring, and apnea with witness, were diagnosed as having OSAHS. They underwent full-night polysomnography and then dynamic 3-D CT imaging of the upper airway during quiet breathing and in Muller’s maneuver. The soft palate length (SPL), the minimal cross-sectional area of the retropalatal region (mXSA-RP), and the vertical distance from the hard palate to the upper posterior part of the hyoid (hhL) were compared between the two breathing states. These parameters, together with hard palate length (HPL), were also compared between mild/moderate and severe OSAHS groups. Association of these parameters with the severity of OSAHS [as reflected by apnea hypopnea index (AHI) and the lowest saturation of blood oxygen (LSaO2)] was examined. The results showed that 31 patients had severe OSAHS, and 10 mild/moderate OSAHS. All the patients had airway obstruction at soft palate level. mXSA-RP was significantly decreased and SPL remarkably increased during Muller’s maneuver as compared with the quiet breathing state. There were no significant differences in these airway parameters (except the position of the hyoid bone) between severe and mild/moderate OSAHS groups. And no significant correlation between these airway parameters and the severity of OSAHS was found. The position of hyoid was lower in the severe OSAHS group than in the mild/moderate OSAHS group. The patients in group with body mass index (BMI)≥26 had higher collapse ratio of mXSA-RP, greater neck circumference and smaller mXSA-RP in the Muller’s maneuver than those in group with BMI<26 (P<0.05 for all). It was concluded that dynamic 3-D CT imaging could dynamically show the upper airway changes at soft palate level in OSAHS patients. All the OSAHS patients had airway obstruction of various degrees at soft palate level. But no correlation was observed between the airway change at soft palate level and the severity of OSAHS. The patients in group with BMI≥26 were more likely to develop airway obstruction at soft palate level than those with BMI<26.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ryan CM, Bradly TD. Pathogenesis of obstructive sleep apnea. J Appl Physiol, 2005,99(6):2440–2450

    Article  PubMed  Google Scholar 

  2. Onal E, Lopata M, O’Connor T. Pathogenesis of apneas in hypersomnia-sleep apnea syndrome. Am Rev Respir Dis, 1982,125(2):167–174

    PubMed  CAS  Google Scholar 

  3. Badr MS. Pathophysiology of upper airway obstruction during sleep. Clin Chest Med, 1998,19(1):21–32

    Article  PubMed  CAS  Google Scholar 

  4. Kuna S, Remmers JE. Anatomy and physiology of upper airway obstruction. Kryger MH, Roth T, Dement WC, ed. Principles and practice of sleep medicine (3nd ed). Philadelphia: WB Saunders, 2000,840–858

    Google Scholar 

  5. Pepin JL, Veale D, Ferretti GR, et al. Obstructive sleep apnea syndrome: Hooked appearance of the soft palate in awake patients: cephalometric and CT findings. Radiol ogy, 1999,210(1):163–170

    CAS  Google Scholar 

  6. Jager L, Gunther E, Gauger J, et al. Fluoroscopic MR of the pharynx in patients with obstructive sleep apnea. AJNR Am J Neuroradiol, 1998,19(7):1205–1214

    PubMed  CAS  Google Scholar 

  7. Suratt PM, Dee P, Atkinson RL, et al. Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis, 1983,127(4):487–492

    PubMed  CAS  Google Scholar 

  8. Lam B, Ooi CG, Peh WC, et al. Computed tomographic evaluation of the role of craniofacial and upper airway morphology in obstructive sleep apnea in Chinese. Resp Med, 2004,98(4):301–307

    Article  Google Scholar 

  9. Haponik EF, Smith PL, Bohlman ME, et al. Computerized tomography in obstructive sleep apnea: correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis, 1983,127(2):221–226

    PubMed  CAS  Google Scholar 

  10. Stein MG, Gamsu G, Geer G, et al. Cine CT in obstructive sleep apnea. AJR Am J Roentgenol, 1987,148(6): 1069–1074

    PubMed  CAS  Google Scholar 

  11. Galvin JR, Rooholamini SA, Stanford W. Obstructive sleep apnea: diagnosis with ultrafast CT. Radiology, 1989,171(3):775–778

    PubMed  CAS  Google Scholar 

  12. Schwab RJ, Gupta KB, Gefter WB, et al. 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(5):1673–1689

    PubMed  CAS  Google Scholar 

  13. Avrahami E, Englender M. Relation between CT axial cross-sectional area of the oropharynx and obstructive sleep apnea syndrome in adults. AJNR Am J Neuroradiol, 1995,16(1):135–140

    PubMed  CAS  Google Scholar 

  14. Avrahami E, Englender M. Relation between CT axial cross-sectional area of the oropharynx and obstructive sleep apnea syndrome in adults. AJNR Am J Neuroradiol, 1995,16(1):135–140

    PubMed  CAS  Google Scholar 

  15. Schwab RJ, Gupta KB, Gefter WB, et al. 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(5):1673–1689

    PubMed  CAS  Google Scholar 

  16. Isono S, Remmers JE. Anatomy and physiology of upper airway obstruction. Kryger MH, ed. Principles and practice of sleep medicine (2nd ed). Philadelphia: Saunders, 1994,642–656

    Google Scholar 

  17. Ritter CT, Trudo FJ, Goldberg AN, et al. Quantitative evaluation of the upper airway during nasopharyngoscopy with the Müller maneuver. Laryngoscope, 1999,109(6):954–963

    Article  PubMed  CAS  Google Scholar 

  18. Schwab RJ, Goldberg AN. Upper airway assessment: radiographic and other imaging techniques. Otolaryngol Clin North Am, 1998,31(6):931–968

    Article  PubMed  CAS  Google Scholar 

  19. Hori Y, Shizuku H, Kondo A, et al. Endoscopic evaluation of dynamic narrowing of the pharynx by the Bernouilli effect producing maneuver in patients with obstructive sleep apnea syndrome. Auris Nasus Larynx, 2006,33(4): 429–432

    Article  PubMed  Google Scholar 

  20. Borowiecki BD, Sassin JF. Surgical treatment of sleep apnea. Arch Otolaryngol, 1983,109(8):508–512

    PubMed  CAS  Google Scholar 

  21. Burger CD, Stanson AW, Daniels BK, et al. Fast-computed tomographic evaluation of the effect of route of breathing on upper airway size and function in normal men. Chest, 1993,103(4):1032–1037

    Article  PubMed  CAS  Google Scholar 

  22. Ryan CF, Lowe AA, Li D, et al. Three-dimensional upper airway computed tomography in obstructive sleep apnea. A prospective study in patients treated by uvulopalatopharyngoplasty. Am Rev Respir Dis, 1991,144(2): 428–432

    PubMed  CAS  Google Scholar 

  23. Caballero P, Alvarez-Sala R, Garcia-Rio F, et al. CT in the evaluation of the upper airway in healthy subjects and in patients with obstructive sleep apnea syndrome. Chest, 1998,113(1):111–116

    Article  PubMed  CAS  Google Scholar 

  24. Lowe AA, Gionhaku N, Takeuchi K, et al. Three-dimensional CT reconstructions of tongue and airway in adult subjects with obstructive sleep apnea. Am J Orthod Dentofacial Orthop, 1986,90(5):364–374

    Article  PubMed  CAS  Google Scholar 

  25. Battagel JM, Johal A. A cephalometric comparison of normal weight and obese subjects with obstructive sleep apnoea. Radiography, 2000,6(4):283–292

    Article  Google Scholar 

  26. Pepin JL, Ferretti G, Veale D, et al. Somnofluoroscopy, computed tomography, and cephalometry in the assessment of the airway in obstructive sleep apnoea. Thorax, 1992,47(3):150–156

    Article  PubMed  CAS  Google Scholar 

  27. Johns FR, Strollo PJ, Buckley M, et al. The influence of craniofacial structure on obstructive sleep apnea in young adults. J Oral Maxillofac Surg, 1998,56(5):596–603

    Article  PubMed  CAS  Google Scholar 

  28. Paoli JR, Lauwers F, Lacassagne L, et al. Craniofacial differences according to the body mass index of patients with obstructive sleep apnoea syndrome: cephalometric study in 85 patients. Br J Oral Max Surg, 2001,39(1):40–45

    Article  CAS  Google Scholar 

  29. Morrell MJ, Arabi Y, Zahn B, et al. Progressive retropalatal narrowing preceding obstructive apnea. Am J Respir Crit Care Med, 1998,158(6):1974–1981

    PubMed  CAS  Google Scholar 

  30. Bhattacharyya N, Blake SP, Fried MP. Assessment of the airway in obstructive sleep apnea syndrome with 3-dimensional airway computed tomography. Otolaryngol Head Neck Surg, 2000,123(4):444–449

    Article  PubMed  CAS  Google Scholar 

  31. Ell SR, Jolles H, Galvin JR. Cine CT demonstration of nonfixed upper airway obstruction. AJR Am J Roentgenol, 1986,146(4):669–667

    PubMed  CAS  Google Scholar 

  32. Yucel A, Unlu M, Haktanir A, et al. Evaluation of the upper airway cross-sectional area changes in different degrees of severity of obstructive sleep apnea syndrome: cephalometric and dynamic CT Study. AJNR Am J Neuroradiol, 2005,26(10):2624–2629

    PubMed  Google Scholar 

  33. Hudgel DW. The role of upper airway anatomy and physiology in obstructive sleep apnea. Clin Chest Med, 1992,13(3):383–398

    PubMed  CAS  Google Scholar 

  34. Ogawa T, Enciso R, Shintaku WH, et al. Evaluation of cross-section airway configuration of obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007,103(1):102–108

    Article  PubMed  Google Scholar 

  35. Shepard JW Jr, Thawley SE. Evaluation of the upper airway by computerized tomography in patients undergoing uvulopalatopharyngoplasty for obstructive sleep apnea. Am Rev Respir Dis,1989,140(3):711–716

    Google Scholar 

  36. Polo OJ, Tafti M, Fraga J, et al. Why don’t all heavy snorers have obstructive sleep apnea? Am Rev Respir Dis, 1991,143(6):1288–1293

    PubMed  CAS  Google Scholar 

  37. Yao M, Utley DS, Terris DJ. Cephalometric parameters after multilevel pharyngeal surgery for patients with obstructive sleep apnea. Laryngoscope, 1998,108(6):789–95

    Article  PubMed  CAS  Google Scholar 

  38. Delides A, Viskos A. Fractal quantitative endoscopic evaluation of the upper airway in patients with obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg, 2010,143(1):85–89

    Article  PubMed  Google Scholar 

  39. Hsu PP, Tan BY, Chan YH, et al. Clinical predictors in obstructive sleep apnea patients with computer-assisted quantitative videoendoscopic upper airway analysis. Laryngoscope, 2004,114(5):791–799

    Article  PubMed  Google Scholar 

  40. Woodson BT, Naganuma H. Comparison of methods of airway evaluation in obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg, 1999,120(4):460–463

    PubMed  CAS  Google Scholar 

  41. Ye J, Han D, Wang J. Computer-assisted fiberoptic pharyngoscopy in obstructive sleep apnea syndrome. ORL J Otorhinolaryngol Relat Spec, 2007, 69(3):153–158

    Article  PubMed  Google Scholar 

  42. Choi JK, Kee WC, Lee JM. Variable site of oropharyngeal narrowing and regional variations of oropharyngeal collapsibility among snoring patients during wakefulness and sleep. Cranio, 2001,19(4):252–259

    PubMed  CAS  Google Scholar 

  43. Abdullah B, Rajet KA, Hamid SS. A videoendoscopic evaluation of the upper airway in South East Asian adults with obstructive sleep apnea. Sleep Breath, 2010 [PMID:20957444]

  44. Heo JY, Kim JS. Correlation between severity of sleep apnea and upper airway morphology: Cephalometry and MD-CT study during awake and sleep states. Acta Otolaryngol, 2011,131(1):84–90

    Article  PubMed  Google Scholar 

  45. Shepard JW Jr, Gefter WB, Guilleminault C, et al. Evaluation of the upper airway in patients with obstructive sleep apnea. Sleep, 1991,14(4):361–371

    PubMed  Google Scholar 

  46. Abramson Z, Susarla S, August M, et al. Three-dime nsional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea. J Oral Maxillofac Surg, 2010,68(2):354–362

    Article  PubMed  Google Scholar 

  47. Baik UB, Suzuki M, Ikeda K, et al. Relationship between cephalometric characteristics and obstructive sites in obstructive sleep apnea syndrome. Angle Orthod, 2002,72(2):124–134

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Ying Xiao  (肖 英), Xiong Chen  (陈 雄), Liechun He  (何烈纯), Jiaqi Dong  (董家琪) & Weijia Kong  (孔维佳)

  2. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Heshui Shi  (史河水) & Yang Yang  (杨 阳)

Authors
  1. Ying Xiao  (肖 英)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiong Chen  (陈 雄)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heshui Shi  (史河水)
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yang Yang  (杨 阳)
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liechun He  (何烈纯)
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jiaqi Dong  (董家琪)
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Weijia Kong  (孔维佳)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Weijia Kong  (孔维佳).

Additional information

Both authors contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xiao, Y., Chen, X., Shi, H. et al. Evaluation of airway obstruction at soft palate level in male patients with obstructive sleep apnea/hypopnea syndrome: Dynamic 3-dimensional CT imaging of upper airway. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 31, 413–418 (2011). https://doi.org/10.1007/s11596-011-0392-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11596-011-0392-5

Key words

Search

Navigation