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. 2023 Jun;27(3):903-912.
doi: 10.1007/s11325-022-02682-3. Epub 2022 Jul 23.

Ultrasonography of the neck in patients with obstructive sleep apnea

Bhavesh Mohan Lal  1 , Surabhi Vyas  2 , Atul Malhotra  3 , Animesh Ray  1 , Gaurav Gupta  1 , Shivam Pandey  4 , R M Pandey  4 , Sandeep Aggarwal  5 , Sanjeev Sinha  6
Affiliations

Ultrasonography of the neck in patients with obstructive sleep apnea

Bhavesh Mohan Lal et al. Sleep Breath. 2023 Jun.

Abstract

Introduction: In resource-limited settings, obstructive sleep apnea (OSA) often goes undiagnosed as polysomnography (PSG) is expensive, time-consuming, and not readily available. Imaging studies of upper airway have been tried as alternatives to PSG to screen for OSA. However, racial differences in upper airway anatomy preclude generalizability of such studies. We sought to test the hypothesis that ultrasonography (USG), an inexpensive, readily available tool to study soft tissue structures of the upper airway, would have predictive value for OSA in South Asian people.

Methods: Adult patients with sleep-related complaints suspicious for OSA were taken for overnight PSG. After the PSG, consecutive patients with and without OSA were studied with submental ultrasonography to measure tongue base thickness (TBT) and lateral pharyngeal wall thickness (LPWT).

Results: Among 50 patients with OSA and 25 controls, mean age was 43.9 ± 11.4 years, and 39 were men. Patients with OSA had higher TBT (6.77 ± 0.63 cm vs 6.34 ± 0.54 cm, P value = 0.004) and higher LPWT (2.47 ± 0.60 cm vs 2.12 ± 0.26 cm, P value = 0.006) compared to patients without OSA. On multivariate analysis, TBT, LPWT, and neck circumference were identified as independent factors associated with OSA. These variables could identify patients with severe OSA with a sensitivity of 72% and a specificity of 76%.

Conclusion: Patients with OSA have higher tongue base thickness and lateral pharyngeal wall thickness proportionate to the severity of the disease, independent of BMI and neck circumference. These findings suggest that sub-mental ultrasonography may be useful to identify patients with severe OSA in resource-limited settings.

Keywords: Apnea–hypopnea index; Lateral pharyngeal wall thickness; Obstructive sleep apnea; Tongue base thickness.

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Conflict of interest statement

Conflict of interest All authors declare that they have no conflict of interest. ResMed provided a philanthropic donation to UC San Diego School of Medicine, San Diego 92121, 358 CA, USA.

Figures

Fig. 1
Fig. 1
This image depicts the measurement of lateral pharyngeal wall thickness. The white arrowheads represent the internal wall of internal carotid artery and the white arrows represent the pharynx. The distance between the two points represents the lateral pharyngeal wall thickness on that side
Fig. 2
Fig. 2
The image depicts the measurement of tongue base thickness. The white bold arrow represents the skin surface and the thin arrows highlight the tongue surface. The red arrow represents the tongue base. The distance between these two points is taken as tongue base thickness
Fig. 3
Fig. 3
Scatter plot demonstrating relationship between AHI and TBT
Fig. 4
Fig. 4
Scatter plot demonstrating relationship between AHI and LPWT
Fig. 5
Fig. 5
Receiver operating characteristics (ROC) curve for predicting the probability of severe OSA using neck circumference, TBT, and LPWT
See this image and copyright information in PMC

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