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. 1992 Mar;47(3):150–156. doi: 10.1136/thx.47.3.150

Somnofluoroscopy, computed tomography, and cephalometry in the assessment of the airway in obstructive sleep apnoea.

J L Pepin 1, G Ferretti 1, D Veale 1, P Romand 1, M Coulomb 1, C Brambilla 1, P A Lévy 1
PMCID: PMC1021002  PMID: 1519190

Abstract

BACKGROUND: Assessments of the upper airways in patients with the obstructive sleep apnoea syndrome are usually carried out on awake patients who are upright. The dynamics of the airway in a patient who is asleep and lying down may be different. METHODS: Somnofluoroscopy, computed tomography of the upper airway, and cephalometry were carried out in 11 patients with the obstructive sleep apnoea syndrome (10 male; mean (SD) age 53 (10) years) to examine the airway while they were awake and asleep. RESULTS: At somnofluoroscopy 10 patients were in stage 2 sleep and only one in REM sleep. At least five obstructive events were visualised by lateral fluoroscopy in each patient. Imaging allowed observation of the dynamics of airway collapse, which began in the oropharynx in all cases, progressing to the hypopharynx in 10 cases and to the laryngopharynx in five. At fluoroscopy the soft palate was seen to hook up during airway occlusion in 10 patients, thereby increasing its cross sectional area. It was then sucked down into the hypopharynx. Somnofluoroscopic and cephalometric findings agreed, eight of the 10 patients with hypopharyngeal collapse shown by somnofluoroscopy having an inferiorly placed hyoid bone according to cephalometry (distance from the mandibular plane to the hyoid bone (MP-H distance) increased); the one patient with no hypopharyngeal collapse had a normal MP-H. By contrast, six of the 11 patients had a normal or supranormal hypopharyngeal cross sectional area of the airway on the computed tomogram. CONCLUSIONS: Somnofluoroscopy allows examination of the dynamics of airway closure in this disorder and shows the important role of the soft palate in acting as a plug in the oropharynx. Dynamic studies are required to determine the pattern of pharyngeal obstruction in obstructive sleep apnoea.

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Selected References

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  1. Bohlman M. E., Haponik E. F., Smith P. L., Allen R. P., Bleecker E. R., Goldman S. M. CT demonstration of pharyngeal narrowing in adult obstructive sleep apnea. AJR Am J Roentgenol. 1983 Mar;140(3):543–548. doi: 10.2214/ajr.140.3.543. [DOI] [PubMed] [Google Scholar]
  2. Bradley T. D., Brown I. G., Grossman R. F., Zamel N., Martinez D., Phillipson E. A., Hoffstein V. Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea. N Engl J Med. 1986 Nov 20;315(21):1327–1331. doi: 10.1056/NEJM198611203152105. [DOI] [PubMed] [Google Scholar]
  3. Cartwright R. D., Lloyd S., Lilie J., Kravitz H. Sleep position training as treatment for sleep apnea syndrome: a preliminary study. Sleep. 1985;8(2):87–94. doi: 10.1093/sleep/8.2.87. [DOI] [PubMed] [Google Scholar]
  4. Ell S. R., Jolles H., Galvin J. R. Cine CT demonstration of nonfixed upper airway obstruction. AJR Am J Roentgenol. 1986 Apr;146(4):669–677. doi: 10.2214/ajr.146.4.669. [DOI] [PubMed] [Google Scholar]
  5. Gould G. A., Whyte K. F., Rhind G. B., Airlie M. A., Catterall J. R., Shapiro C. M., Douglas N. J. The sleep hypopnea syndrome. Am Rev Respir Dis. 1988 Apr;137(4):895–898. doi: 10.1164/ajrccm/137.4.895. [DOI] [PubMed] [Google Scholar]
  6. Guilleminault C., Hill M. W., Simmons F. B., Dement W. C. Obstructive sleep apnea: electromyographic and fiberoptic studies. Exp Neurol. 1978 Oct;62(1):48–67. doi: 10.1016/0014-4886(78)90040-7. [DOI] [PubMed] [Google Scholar]
  7. Guilleminault C., Quera-Salva M. A., Partinen M., Jamieson A. Women and the obstructive sleep apnea syndrome. Chest. 1988 Jan;93(1):104–109. doi: 10.1378/chest.93.1.104. [DOI] [PubMed] [Google Scholar]
  8. Haponik E. F., Smith P. L., Bohlman M. E., Allen R. P., Goldman S. M., Bleecker E. R. Computerized tomography in obstructive sleep apnea. Correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis. 1983 Feb;127(2):221–226. doi: 10.1164/arrd.1983.127.2.221. [DOI] [PubMed] [Google Scholar]
  9. Horner R. L., Shea S. A., McIvor J., Guz A. Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea. Q J Med. 1989 Aug;72(268):719–735. [PubMed] [Google Scholar]
  10. Partinen M., Guilleminault C., Quera-Salva M. A., Jamieson A. Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest. 1988 Jun;93(6):1199–1205. doi: 10.1378/chest.93.6.1199. [DOI] [PubMed] [Google Scholar]
  11. Remmers J. E., deGroot W. J., Sauerland E. K., Anch A. M. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol Respir Environ Exerc Physiol. 1978 Jun;44(6):931–938. doi: 10.1152/jappl.1978.44.6.931. [DOI] [PubMed] [Google Scholar]
  12. Riley R., Guilleminault C., Herran J., Powell N. Cephalometric analyses and flow-volume loops in obstructive sleep apnea patients. Sleep. 1983;6(4):303–311. doi: 10.1093/sleep/6.4.303. [DOI] [PubMed] [Google Scholar]
  13. Rivlin J., Hoffstein V., Kalbfleisch J., McNicholas W., Zamel N., Bryan A. C. Upper airway morphology in patients with idiopathic obstructive sleep apnea. Am Rev Respir Dis. 1984 Mar;129(3):355–360. doi: 10.1164/arrd.1984.129.3.355. [DOI] [PubMed] [Google Scholar]
  14. Schwartz B. A., Escande J. P. Etude cinéradiographique de la respiration hypnique pickwickienne. Rev Neurol (Paris) 1967 Jun;116(6):677–678. [PubMed] [Google Scholar]
  15. Shepard J. W., Jr, Thawley S. E. Evaluation of the upper airway by computerized tomography in patients undergoing uvulopalatopharyngoplasty for obstructive sleep apnea. Am Rev Respir Dis. 1989 Sep;140(3):711–716. doi: 10.1164/ajrccm/140.3.711. [DOI] [PubMed] [Google Scholar]
  16. Smith T. H., Baska R. E., Francisco C. B., McCray G. M., Kunz S. Sleep apnea syndrome: diagnosis of upper airway obstruction by fluoroscopy. J Pediatr. 1978 Nov;93(5):891–892. doi: 10.1016/s0022-3476(78)81119-6. [DOI] [PubMed] [Google Scholar]
  17. Stauffer J. L., Buick M. K., Bixler E. O., Sharkey F. E., Abt A. B., Manders E. K., Kales A., Cadieux R. J., Barry J. D., Zwillich C. W. Morphology of the uvula in obstructive sleep apnea. Am Rev Respir Dis. 1989 Sep;140(3):724–728. doi: 10.1164/ajrccm/140.3.724. [DOI] [PubMed] [Google Scholar]
  18. Stauffer J. L., Zwillich C. W., Cadieux R. J., Bixler E. O., Kales A., Varano L. A., White D. P. Pharyngeal size and resistance in obstructive sleep apnea. Am Rev Respir Dis. 1987 Sep;136(3):623–627. doi: 10.1164/ajrccm/136.3.623. [DOI] [PubMed] [Google Scholar]
  19. Suratt P. M., Dee P., Atkinson R. L., Armstrong P., Wilhoit S. C. Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis. 1983 Apr;127(4):487–492. doi: 10.1164/arrd.1983.127.4.487. [DOI] [PubMed] [Google Scholar]
  20. deBerry-Borowiecki B., Kukwa A., Blanks R. H. Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope. 1988 Feb;98(2):226–234. doi: 10.1288/00005537-198802000-00021. [DOI] [PubMed] [Google Scholar]

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