Anatomic Features of the Nasal and Pharyngeal Region Do Not Influence PAP Therapy Response

Abstract

The objective of this study was to investigate to which extent anatomic features of the nasal and pharyngeal region contribute to the severity of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy response. Therefore, 93 patients (mean age 57.5 ± 13.0 years, mean body mass index 32.2 ± 5.80 kg/m², 75 males, 18 females) diagnosed with OSA who subsequently started PAP therapy were randomly selected from the databank of a sleep laboratory of a tertiary university medical center. Patients were subdivided based on nasal anatomy (septal deviation, turbinate hyperplasia, their combination, or none of the above), pharyngeal anatomy (webbing, tonsillar hyperplasia, their combination, or none of the above), and (as a separate group) tongue base anatomy (no tongue base hyperplasia or tongue base hyperplasia). Then, polysomnographic data (e.g., arousal index, ARI; respiratory disturbance index, RDI; apnea index, AI; hypopnea index, HI; and oxygen desaturation index, ODI) of diagnostic polysomnography (PSG) and PAP therapy control PSG were collected, grouped, and evaluated. Septal deviation, turbinate hyperplasia, or their combination did not significantly affect the assessed PSG parameters or the response to PAP therapy compared with patients without nasal obstruction (p > 0.05 for all parameters). Accordingly, most PSG parameters and the response to PAP therapy were not significantly affected by webbing, tonsil hyperplasia, or their combination compared with patients without pharyngeal obstruction (p > 0.05 for RDI, AI, HI, and ODI, respectively). However, in the pharyngeal anatomy group, ARI was significantly higher in patients with tonsil hyperplasia (p = 0.018). Further, patients with tongue base hyperplasia showed a significantly higher HI in the diagnostic PSG (p = 0.025) compared with patients with normal tongue base anatomy, but tongue base anatomy did not significantly affect the response to PAP therapy (p > 0.05 for all parameters). The influence of anatomic features of the nasal and pharyngeal region on PAP therapy response appears to be small, and generalizability of these results requires further studies.

Keywords: OSA; PAP; nasal obstruction; obstructive sleep apnea; pharyngeal obstruction; positive airway pressure.

Figure 1

Effect of nasal obstruction on the respiratory disturbance index in diagnostic and positive airway pressure therapy control polysomnography. “Absent”—no nasal obstruction; “SD”—septal deviation present; “TH”—turbinate hyperplasia present; “SD + TH”—septal deviation and turbinate hyperplasia present. Further abbreviations: PAP—positive airway pressure; PSG—polysomnography; RDI—respiratory disturbance index.

Figure 2

Effect of pharyngeal obstruction on the respiratory disturbance index in diagnostic and positive airway pressure therapy control polysomnography. “Absent”—no pharyngeal obstruction; “Web.”—webbing present; “TH”—tonsil hyperplasia present; “Web. + TH”—webbing and tonsil hyperplasia present. Further abbreviations: PAP—positive airway pressure; PSG—polysomnography; RDI—respiratory disturbance index.

Figure 3

Effect of tongue base anatomy on the respiratory disturbance index in diagnostic and positive airway pressure therapy control polysomnography. “Absent”—no tongue base hyperplasia; “Present”—tongue base hyperplasia present. Further abbreviations: PAP—positive airway pressure; PSG—polysomnography; RDI—respiratory disturbance index.