Clin Exp Otorhinolaryngol.  2016 Sep;9(3):226-232. 10.21053/ceo.2015.01375.

Assessment of Change in Palatal Sensation in Obstructive Sleep Apnea Patients by Using Two-Point Palatal Discrimination

• Jeong KH
• Yang Y
• Choi HR
• Cho JH
• Kim GT
• Kim JK

• KMID: 2353620
• DOI: http://doi.org/10.21053/ceo.2015.01375

Abstract

OBJECTIVES
Patients with obstructive sleep apnea syndrome (OSAS) have impaired responses to inspiratory resistive loading during sleep. This may be due, in part, to a change in the upper airway sensation. Therefore, we hypothesized that patients with OSAS have diminished upper airway sensation due to snoring.
METHODS
A total of 53 participants were selected based on clinical evaluation and polysomnography. Two-point discrimination was measured with modified calipers in the tongue and soft palate.
RESULTS
A total of 10 participants were included in the control group, 12 participants in the simple snoring group, and 27 participants in the OSAS group. There were 12 patients in the impaired sensation group of the OSAS group. On comparing polysomnography, patients with impairment of their palatal sensory input in two-point discrimination (TPD) had a more protracted duration of the longest snoring episode than those with simple snoring and normal sensation. Patients with decreased sensory input in TPD had longer average duration of snoring episodes and relative snoring time than those with simple snoring and normal sensory input in cold uvular TPD. Comparison of the cold uvular TPD for normal sensation and impaired sensation in patients with OSAS after treatment showed a different trend.
CONCLUSION
Impaired sensation of the soft palate was correlated with the longest snoring episode duration, average snoring episode duration, and relative snoring time. It is helpful in detecting the early stage of neural degradation in OSAS patients by assessing snoring components of polysomnography and TPD in the soft palate.

Keyword

Sensory Neuropathy; Sleep Apnea Syndromes; Snoring; Polysomnography; Palate, Soft

MeSH Terms

Discrimination (Psychology)*
Humans
Hypesthesia
Palate, Soft
Polysomnography
Sensation*
Sleep Apnea Syndromes
Sleep Apnea, Obstructive*
Snoring
Tongue

Figure

• 

  Fig. 1. Modifi ed caliper device. Special compass-like device consisting of temperature display and control buttons (A), scale (B), and thermode with a screw system (arrow).

• 

  Fig. 2. Demographics of subjects. A total of 49 patients were enrolled. The number of subjects in the control group was 10, that in the simple snoring group was 12, that in the normal sensation group of the OSAS group was 15, and that in the impaired sensation group of the OSAS group was 12. AHI, apnea-hypopnea index; TPD, two-point detection; OSAS, obstructive sleep apnea syndrome.

• 

  Fig. 3. (A) Longest snoring episode (min). The impaired sensation group of the OSAS group showed a significant difference. The mean±SD was 15.6±10.3 in the impaired sensation group, 7.4±5.6 in the simple snoring group, and 3.9±4.5 in the normal sensation group of the OSAS group. Symbol (*) indicates statistical significance. (B) Average snoring episode duration (minute). The impaired sensation group of the OSAS group showed a significantly longer duration than the other groups. The mean±SD was 0.7±0.4 in the impaired sensation group, 0.4±0.2 in the simple snoring group, and 0.4±0.3 in the normal sensation group of the OSAS group. Symbol (*) indicates statistical significance. OSAS, obstructive sleep apnea syndrome.

• 

  Fig. 4. (A) Relative snoring time (%). The mean±SD was 16.8±4.8 in the simple snoring group, 18.2±11.3 in the normal sensation group, and 28.7±10.8 in the impaired sensation group of the OSAS group. The impaired sensation group showed a significant difference. Symbol (*) indicates statistical significance. (B) Lowest O2 saturation (%). The mean±SD was 86.9±3.5 in the simple snoring group, 80.7±6.8 in the normal sensation group, and 79.9±6.5 in the impaired sensation group of the OSAS group. There was no significant difference between the normal and impaired sensation groups except in the simple snoring group. Symbol (*) indicates statistical significance. OSAS, obstructive sleep apnea syndrome.

• 

  Fig. 5. Alteration of cold TPD between the normal and impaired sensation groups of the OSAS group. Compared to the mean before treatment, the mean after treatment in the normal sensation group did not change signifi cantly for cold TPD (P=0.291). In the impaired sensation group, the cold uvular TPD before treatment was increased without statistical signifi cance (P=0.392). Symbol (*) indicates statistical signifi cance. NS_before, the normal sensation group before treatment; NS_after, the normal sensation group after treatment; IS_before, the impaired sensation group before treatment; IS_after, the impaired sensation group after treatment; TPD, two-point detection; OSAS, obstructive sleep apnea syndrome.

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