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. 2019 Aug 15;45(4):e20180264.
doi: 10.1590/1806-3713/e20180264.

State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea

[Article in English, Portuguese]
Ula Lindoso Passos  1 , Pedro Rodrigues Genta  1 , Bianca Fernandes Marcondes  2 , Geraldo Lorenzi-Filho  2 , Eloisa Maria Mello Santiago Gebrim  1
Affiliations

State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea

[Article in English, Portuguese]
Ula Lindoso Passos et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position.

Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states.

Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects.

Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.

Objetivo:: Determinar se o estreitamento das vias aéreas durante eventos obstrutivos ocorre predominantemente na região retropalatal e resulta de alterações dinâmicas nas paredes laterais da faringe e na posição da língua.

Métodos:: Avaliamos 11 pacientes com apneia obstrutiva do sono (AOS) grave (grupo AOS) e 7 indivíduos saudáveis sem AOS (grupo controle) durante a vigília e o sono natural (documentado por meio de polissonografia completa). Por meio de TC multidetectores rápida, obtivemos imagens das vias aéreas superiores no estado de vigília e de sono.

Resultados:: O estreitamento das vias aéreas superiores durante o sono foi significativamente maior na região retropalatal do que na região retrolingual no grupo AOS (p < 0,001) e no grupo controle (p < 0,05). O volume da via aérea retropalatal foi menor no grupo AOS do que no grupo controle durante a vigília (p < 0,05) e diminuiu significativamente da vigília ao sono apenas no grupo AOS. O estreitamento retropalatal da faringe foi atribuído à redução do diâmetro anteroposterior (p = 0,001) e lateral (p = 0,006), que se correlacionou com o aumento do volume das paredes laterais da faringe (p = 0,001) e o deslocamento posterior da língua (p = 0,001). Não ocorreu estreitamento retrolingual da faringe durante o sono no grupo AOS.

Conclusões:: Em pacientes com AOS, o estreitamento das vias aéreas superiores durante o sono ocorre predominantemente na região retropalatal e afeta as dimensões anteroposterior e lateral, além de estar relacionado com aumento das paredes laterais da faringe e deslocamento posterior da língua.

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Figures

Figure 1
Figure 1. Representative axial and sagittal CT reconstructions of the pharynx during wakefulness in a patient with obstructive sleep apnea. Retropalatal region (A), at the level of the superior border of the C2 vertebral body (* in B), and retroglossal region (C). Contour of the lateral wall (blue outline in B) and lateral wall thickness (solid line in A); anteroposterior diameter of the pharynx (dotted lines in A, C, and D) and lateral diameter of the pharynx (dashed line in A and C); tongue-pharyngeal distance (white dotted line in D); retroglossal area (solid contour in C) and tongue delimitation (red area in D).
Figure 2
Figure 2. Axial CT images of the retropalatal (RP) and retroglossal (RG) regions (A and B, respectively). The lateral pharyngeal walls are delimited medially by air. The black line in A represents the anterior aspect of the medial border of the lateral pharyngeal wall. The glossotonsillar sulcus (arrows) marks the anterior limit of the lateral pharyngeal wall at the RG level (B). The lateral pharyngeal wall is delimited laterally by the parapharyngeal space and posteriorly by the retropharyngeal space.
Figure 3
Figure 3. Three-dimensional reconstructions of the upper airway of a representative control subject (A and B) and of a patient with obstructive sleep apnea (OSA; C and D). The lateral pharyngeal walls (in red) and the airway lumen (in blue) during wakefulness (A and C) and sleep (B and D). From wakefulness to sleep, the lateral walls and airway lumen remained unchanged in the control subject, whereas there was widening of the lateral pharyngeal walls and narrowing of the airway lumen in the patient with OSA.
Figure 4
Figure 4. Individual changes in retropalatal upper airway volume and lateral pharyngeal wall volume (A and B, respectively) from the waking state to the sleep state among control and obstructive sleep apnea (OSA) group subjects. Short horizontal lines and bars indicate means and standard deviations, respectively. ns: not significant.
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