Pharyngeal Wall Floppiness: A Novel Technique to Detect Upper Airway Collapsibility in Patients ...

Pharyngeal Wall Floppiness: A Novel Technique to Detect Upper Airway Collapsibility in Patients ...

6 Pages · 2015 · 593 KB · English

sor. Moreover, PWF was calculated from the difference of pharyngeal cavity volumes under positive and negative pres- sures divided by the sum of the volumes under positive and negative pressures. The measurements were conducted on a group of 7 subjects weekly over 3 consecutive weeks to eval-.

Pharyngeal Wall Floppiness: A Novel Technique to Detect Upper Airway Collapsibility in Patients ... free download


Original Research—Sleep Medicine and Surgery Pharyngeal Wall Floppiness: A Novel Technique to Detect Upper Airway Collapsibility in Patients with OSAS Otolaryngology– Head and Neck Surgery 2015, Vol 152(4) 759–764 American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015 Reprints and permission: sagepubcom/journalsPermissionsnav DOI: 101177/0194599814562728 http://otojournalorg Wei Qian, MD, PhD 1, Junxiang Tang, MSc 1, Guochang Jiang 1, and Lin Zhao, RN 1 Sponsorships or competing interests that may be relevant to content are dis closed at the end of this article Abstract Objective To measure pharyngeal wall floppiness (PWF) under different pressures, a novel method and technique were introduced in the present study Study Design A prospective clinical study Subjects and Methods Fortyseven healthy subjects (32 male; mean age, 379 years) and 49 patients with obstructive sleep apnea syndrome (OSAS) (46 male; mean age, 4145 years) were recruited The pharyngeal cavity volume was measured by acoustic reflection under positive (10 cm H 2O) and nega tive ( 210 cm H 2O) pressures The pharyngeal cavity volume was detected from the segment of 10 to 20 cm from the inci sor Moreover, PWF was calculated from the difference of pharyngeal cavity volumes under positive and negative pres sures divided by the sum of the volumes under positive and negative pressures The measurements were conducted on a group of 7 subjects weekly over 3 consecutive weeks to eval uate testretest variability Results The mean PWF was 019 6011 in healthy subjects and 024 6007 in the OSAS group, with a significant differ ence ( P\ 01) There was moderate positive correlation between PWF and age or body mass index in healthy sub jects In the 7 subjects, the mean measured interclass corre lation coefficient was 09 ( P\ 05) in 3 consecutive weekly measurements Conclusion The OSAS population had greater PWF com pared to healthy subjects The age dependency of PWF in healthy subjects implied which might play important roles in the development of OSAS This noninvasive and reproduci ble technique might be a useful tool in OSAS clinical applications Keywords upper airway, obstruction, pharyngeal wall, sleep apnea Received August 7, 2014; revised October 22, 2014; accepted November 14, 2014 O bstructive sleep apnea syndrome (OSAS) is a common respiratory disorder and an independent risk factor for many diseases such as hypertension, cardiovascular events, and arrhythmias 13 The syndrome can affect any age group and is estimated to affect 2% to 4% of the adult population 4Several lines of evidence sug gest that aging could predispose the patient to OSAS by increases in pharyngeal collapsibility during sleep, although this has not been directly demonstrated 511 Essentially, OSAS is character ized by episodes of partial or complete obstruction of the upper airway during sleep, inter rupting (apnea) or reducing (hypopnea) the flow of air, fol lowedbytransientawakeningthatleadstoreopeningofthe upper airway Within the upper airway, the pharynx is the region where most obstructive p rocesses leading to OSAS are found 12 Several factors, including genioglossal muscle dys function, excessive or elongat ed tissues of the soft palate, macroglossia, tonsillar hyper trophy, redundant pharyngeal mucosa, increased adipose tissue in the region of the neck with fat infiltration, and edema in the soft palate, are impli cated in the development of OSAS 1315 To determine the site and degree of upper airway obst ruction in OSAS, studies have introduced different techniques such as fluoroscopy, cephalo metry, computed tomography (CT) and magnetic resonance imaging (MRI), sonographic measurement, and anatomic opti cal coherence tomography 1619 However, these methods have not been systematically applie d during sleep because of the difficulty in achieving sleep in sc anners, on a breathbybreath basis, or the time constraints of image acquisition 2023 Acoustic pharyngometry is a technique utilizing acoustic reflection to detect the airway geometry 24 Studies compared this technique and other traditional diagnostic methods as applied to OSAS and found no statis tically significant difference 1Department of Otolaryngology, Jiangsu University Affiliated People’s Hospital, Zhenjiang, China This article was presented at the 2014 AAOHNSF Annual Meeting and OTO EXPO; September 2124, 2014; Orlando, Florida Corresponding Author: Wei Qian, MD, PhD, Department of Otolaryngology, Jiangsu University Affiliated People’s Hospital, 8 Dianli Road, Zhenjiang, Jiangsu, 212002, China Email: [email protected] at SOCIEDADE BRASILEIRA DE CIRUR on April 6, 2015 otosagepubcom Downloaded from between these techniques, 25,26 which implied that acoustic phar yngometry should be informati ve in clinical

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