Adult obstructive sleep apnoea and the larynx

Abstract

The larynx plays an important role in assessment and treatment of adult sleep apnoea. Laryngeal afferent sensory pathways play a critical role in reflexes controlling airway patency during sleep. Airway obstruction at the laryngeal level should be considered and assessed especially in OSA patients nonresponsive to standard therapies. Isolated laryngeal airway obstruction is rare but identification of specific conditions is important as they are amenable to appropriate treatments. OSA can also affect normal laryngeal function. People with OSA exhibit higher levels of laryngeal inflammation, laryngopharyngeal reflux, and chronic cough. Treatment with continuous positive airway pressure has a potential role in improving laryngeal symptomatology in these cases.

Evaluation of the pharyngeal airway using computational fluid dynamics in patients with acromegaly

“…Anatomic abnormalities in the upper airways of patients with acromegaly can restrict spontaneous breathing. Obstructive sleep apnea (OSA) is strongly associated with acromegaly, occurring in up to 70% of individuals, and is a result of obstruction at the laryngeal level caused by hypertrophy of supraglottic soft tissue, including the tongue, soft palate, epiglottis, and aryepiglottic folds, or decreased vocal fold mobility . Chung et al recently reported that 5.0% of patients undergoing trans‐sphenoidal pituitary surgery (TSS) have the comorbidity of OSA and that OSA is independently associated with increased risks of postoperative tracheostomy and hypoxemia after TSS .…”

“…Obstructive sleep apnea (OSA) is strongly associated with acromegaly, occurring in up to 70% of individuals, and is a result of obstruction at the laryngeal level caused by hypertrophy of supraglottic soft tissue, including the tongue, soft palate, epiglottis, and aryepiglottic folds, or decreased vocal fold mobility. 1 Chung et al recently reported that 5.0% of patients undergoing trans-sphenoidal pituitary surgery (TSS) have the comorbidity of OSA and that OSA is independently associated with increased risks of postoperative tracheostomy and hypoxemia after TSS. 2 Although the incidence of airway-related postoperative complications has not been established, Munish et al have reported that patients with high-risk OSA according to the American Society of Anesthesiologists checklist have a higher incidence of postoperative hypoxia (16.8% vs. 10.2%), defined as one or more instances of pulse oximetry values of <90% on 2-3 L/min oxygen by nasal cannula, and more frequently require tracheal reintubation (4.9% vs. 0.9%) than do matched controls with low-risk OSA.…”

A possible association between dysphonia and sleep duration: A cross-sectional study based on the Korean National Health and nutrition examination surveys from 2010 to 2012

“…It is thus likely that sleep deprivation affects dysphonia development more than does excessive sleep; short sleep may be caused by insomnia, a psychiatric disorder, or obstructive sleep apnea (OSA). In particular, OSA may cause poor sleep and voice problems; bidirectional relationships have been found between OSA, on the one hand, and laryngeal sensory disturbances, laryngopharyngeal reflux, and a chronic cough, on the other [ 34 – 37 ]. OSA is a common sleep-related breathing disorder characterized principally by repetitive episodes of obstructive apnea and hypopnea during sleep [ 38 ].…”

HIF-1α-Mediated, NADPH Oxidase-Derived ROS Contributes to Laryngeal Airway Hyperreactivity Induced by Intermittent Hypoxia in Rats

“…Obstructive sleep apnea (OSA), characterized by intermittent hypoxia (IH) during sleep, is associated with laryngeal airway hyperreactivity (LAH) and laryngeal inflammation (Nandwani et al, 1998;Novakovic and MacKay, 2015). LAH is manifested by the increased sensitivity of laryngeal afferents to stimulants and further exaggerate several airway reflexes, such as cough (Hansson et al, 1992;Mutoh et al, 2000), apnea (Naida et al, 1996;Tsai et al, 2006;Liu et al, 2013), and laryngospasm (Mazzone and Canning, 2002).…”

“…Among these laryngeal afferents, capsaicin-sensitive superior laryngeal nerves (SLNs), constituting a subpopulation of nociceptive-like free nerve endings, are highly sensitive to various inflammatory mediators (Tsai et al, 2009;Liu et al, 2013). Activation of capsaicin-sensitive SLNs may evoke a number of respiratory reflexes, such as apnea, cough, and glottis-stop reflex (Prudon et al, 2005;Liu et al, 2013), many of which are clinical signs of patients with OSA (Novakovic and MacKay, 2015;Gouveia et al, 2019). Also, patients with OSA exhibit chronic cough, a major symptom of LAH, which may be related to the degree of inflammatory markers in the airways (Chan et al, 2015).…”