Clin Exp Otorhinolaryngol.  2010 Sep;3(3):147-152.

Differences of Upper Airway Morphology According to Obesity: Study with Cephalometry and Dynamic MD-CT

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University School of Medicine, Daegu, Korea. sookim@knu.ac.kr
  • 2Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea.

Abstract


OBJECTIVES
We investigated difference of parameters of polysomnography, cephalometry and dynamic multi-detector computerized tomography (MD-CT) in wake and sleep states according to obesity.
METHODS
We evaluated 93 patients who underwent polysomnography and cephalometry. MD-CT was performed in 68 of these 93 patients. Fifty-nine and 34 patients were classified as obese and non-obese, with obesity defined as BMI > or =25. Cephalometry results were analyzed for 12 variables. Using the MD-CT, we evaluated dynamic upper airway morphology in wake and sleep states and divided the upper airway into four parts named as high retropalatal (HRP), low retropalatal (LRP), high retroglossal (HRG), and low retroglossal (LRG). A minimal cross sectional area (mCSA) and collapsibility index (CI) were calculated for each airway level.
RESULTS
Diastolic blood pressure (P=0.0005), neck circumference (P<0.0001), and apnea-hypopnea index (P<0.0001) were statistically significantly different between the obese and non-obese group. Among 12 cephalometric variables, there was a significant difference in only the distance from mandibular plane to hyoid bone (P=0.003). There was statistical difference in CI of HRG and LRG in sleep state (P=0.0449, 0.0281) but no difference in mCSA in wake and sleep states.
CONCLUSION
The obese group had more severe sleep apnea than the non-obese group. We believe that the increased severity of apnea in the obese group may be have been due to increased collapsibility of the upper airway rather than decreased size of the upper airway.

Keyword

Snoring; Sleep apnea; CT scan; Obesity

MeSH Terms

Apnea
Blood Pressure
Cephalometry
Humans
Hyoid Bone
Neck
Obesity
Polysomnography
Sleep Apnea Syndromes
Snoring

Figure

  • Fig. 1 Schematic lateral view of the upper airway. The site of obstruction is classified as one of four levels. The area from the inferior border of the hard palate to the inferior border of the uvula is classified as the retropalate level; the area from the inferior border of the uvula to the superior border of the epiglottis tip as the retroglossal level. Each of these two levels are further divided into 'high' and 'low' levels.HRP: high retropalatal area; LRP: low retropalatal area; HRG: high retroglossal area; LRG: low retroglossal area.

  • Fig. 2 Simulated longitudinal display of the oropharynx showing the results of multi-detector computerized tomography in wake and sleep states. coronal: coronal scout view of oropharynx; sagittal: sagittal scout view of oropharynx; phase I: minimal cross-sectional area (mCSA) of oropharynx in wake state; phase II: mCSA of oropharynx in sleep state; phase I*: dynamic imaging of mCSA according to respiration in wake state; phase II*: dynamic imaging of mCSA according to respiration in sleep state; HRP: high retropalatal area; LRP: low retropalatal area; HRG: high retroglossal area; LRG: low retroglossal area. The U indicates uvular levels of oropharynx.


Reference

1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 4. 328(17):1230–1235. PMID: 8464434.
Article
2. Kim J, In K, You S, Kang K, Shim J, Lee S, et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med. 2004; 11. 170(10):1108–1113. PMID: 15347562.
Article
3. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002; 4. 162(8):893–900. PMID: 11966340.
4. Vgontzas AN, Papanicolaou DA, Bixler EO, Hopper K, Lotsikas A, Lin HM, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000; 3. 85(3):1151–1158. PMID: 10720054.
Article
5. Rubinstein I, Colapinto N, Rotstein LE, Brown IG, Hoffstein V. Improvement in upper airway function after weight loss in patients with obstructive sleep apnea. Am Rev Respir Dis. 1988; 11. 138(5):1192–1195. PMID: 3202479.
Article
6. Faber CE, Grymer L. Available techniques for objective assessment of upper airway narrowing in snoring and sleep apnea. Sleep Breath. 2003; 6. 7(2):77–86. PMID: 12861487.
Article
7. Hou HM, Hagg U, Sam K, Rabie AB, Wong RW, Lam B, et al. Dentofacial characteristics of Chinese obstructive sleep apnea patients in relation to obesity and severity. Angle Orthod. 2006; 11. 76(6):962–969. PMID: 17090158.
Article
8. Cuccia AM, Campisi G, Cannavale R, Colella G. Obesity and craniofacial variables in subjects with obstructive sleep apnea syndrome: comparisons of cephalometric values. Head Face Med. 2007; 12. 22. 3:41. PMID: 18154686.
Article
9. Tangugsorn V, Krogstad O, Espeland L, Lyberg T. Obstructive sleep apnea: a canonical correlation of cephalometric and selected demographic variables in obese and nonobese patients. Angle Orthod. 2001; 2. 71(1):23–35. PMID: 11211294.
10. Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J. 1999; 2. 13(2):403–410. PMID: 10065689.
Article
11. Ferguson KA, Ono T, Lowe AA, Ryan CF, Fleetham JA. The relationship between obesity and craniofacial structure in obstructive sleep apnea. Chest. 1995; 8. 108(2):375–381. PMID: 7634870.
Article
12. Lee KY, Lee CM, Choi YJ, Lee YJ, Jung SS, Kim JS. Comparison of electron beam tomography and multi detector computed tomography for dynamic upper airway study in snorers. J Rhinol. 2004; 11. 11(1,2):57–61.
13. Ryan CM, Bradley TD. Pathogenesis of obstructive sleep apnea. J Appl Physiol. 2005; 12. 99(6):2440–2450. PMID: 16288102.
Article
14. Suratt PM, Dee P, Atkinson RL, Armstrong P, Wilhoit SC. Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis. 1983; 4. 127(4):487–492. PMID: 6838055.
Article
15. Ye MK, Shin SH, Kim CG, Lee SH, Lee JM, Choi JK. Dynamic upper airway study in snoring subjects using electron beam Tomography. Korean J Otolaryngol-Head Neck Surg. 2003; 2. 46(2):120–125.
16. Horner RL, Mohiaddin RH, Lowell DG, Shea SA, Burman ED, Longmore DB, et al. Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls. Eur Respir J. 1989; 7. 2(7):613–622. PMID: 2776867.
17. Shelton KE, Woodson H, Gay S, Suratt PM. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis. 1993; 8. 148(2):462–466. PMID: 8342912.
Article
18. Katz I, Stradling J, Slutsky AS, Zamel N, Hoffstein V. Do patients with obstructive sleep apnea have thick necks? Am Rev Respir Dis. 1990; 5. 141(5 Pt 1):1228–1231. PMID: 2339843.
Article
19. Hla KM, Young TB, Bidwell T, Palta M, Skatrud JB, Dempsey J. Sleep apnea and hypertension: a population-based study. Ann Intern Med. 1994; 3. 120(5):382–388. PMID: 8304655.
Article
20. Hoffstein V, Mateika S. Differences in abdominal and neck circumferences in patients with and without obstructive sleep apnoea. Eur Respir J. 1992; 4. 5(4):377–381. PMID: 1563498.
21. Young JW, McDonald JP. An investigation into the relationship between the severity of obstructive sleep apnoea/hypopnoea syndrome and the vertical position of the hyoid bone. Surgeon. 2004; 6. 2(3):145–151. PMID: 15570816.
Article
22. Tsuchiya M, Lowe AA, Pae EK, Fleetham JA. Obstructive sleep apnea subtypes by cluster analysis. Am J Orthod Dentofacial Orthop. 1992; 6. 101(6):533–542. PMID: 1598893.
Article
23. Sforza E, Bacon W, Weiss T, Thibault A, Petiau C, Krieger J. Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2000; 2. 161(2 Pt 1):347–352. PMID: 10673170.
Article
24. Yucel A, Unlu M, Haktanir A, Acar M, Fidan F. 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; Nov–Dec. 26(10):2624–2629. PMID: 16286412.
25. Fajdiga I. Snoring imaging: could Bernoulli explain it all? Chest. 2005; 8. 128(2):896–901. PMID: 16100183.
26. Barkdull GC, Kohl CA, Patel M, Davidson TM. Computed tomography imaging of patients with obstructive sleep apnea. Laryngoscope. 2008; 8. 118(8):1486–1492. PMID: 18528305.
Article
27. Leiter JC, Knuth SL, Krol RC, Bartlett D Jr. The effect of diazepam on genioglossal muscle activity in normal human subjects. Am Rev Respir Dis. 1985; 8. 132(2):216–219. PMID: 3927805.
Full Text Links
  • CEO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr