Effects of mass loading on the upper airway

Koenig, Joel; Thach, Bradley T.

doi:10.1152/jappl.1988.64.6.2294

Cited by 92 publications

(52 citation statements)

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“…1,2,15 In pa ti ents with OSAS, obe sity is res pon sib le for an in cre a se in neck si ze; this so-cal led 'neck obe sity' has be en imp li ca ted in the pat hoph ysi ology of up per air way obs truc ti on du ring sle ep du e to fat com pres si on of the pharynx. 33,34 In our study, all ma jor symptoms re la ted with SDB we re sig ni ficantly hig her in the obe se po pu la ti on. The high pre va len ces of wit nes sed ap ne a and ex ces si ve dayti me sle e pi ness in wo men in our study was con side red to be du e to the ir obesity, since the women were mo re obe se than men in our samp le.…”

Section: Discussionsupporting

confidence: 48%

“…To analy ze the in de pen dent inf lu en ce of snoring on the so ma tic di se a ses, mul ti va ri a te mo dels we re used, with ad just ment for age, BMI, al co hol ad dic ti on and smo king sta tus. Age was ca te go ri zed in to in ter vals (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), 45-64, 65-74, >75) in the mul tip le analy sis, whi le BMI was ca te go ri zed in to fo ur in ter vals (<25: nor mal, 25.0-29.9: overwe ight, 30.0-39.9: obe se, >40: mor bid obe se).…”

Section: Sta Tis Ti Cal Analy Sismentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of Sleep Disordered Breathing Symptoms and Their Relation with Concomitant Diseases in Afyon, Turkey: A Population Based Study

Ünlü¹,

Sezer²,

Fidan³

et al. 2010

Turkiye Klinikleri J Med Sci

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150leep disordered breathing (SDB) is a common syndrome.1,2 It is associated with various medical problems [3][4][5] that have impact on morbidity and mortality. It also causes an additional burden of the public health Prevalence of Sleep Disordered BreathingSymptoms and Their Relation with Concomitant Diseases in Afyon, Turkey:A Population Based Study A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: : To es ti ma te the pre va len ce of symptoms of sle ep-di sor de red bre at hing (SDB) and to eva lu a te the re la ti ons hip bet we en the se symptoms and con co mi tant syste mic di sorders in Tur kish adults. M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: : A samp le gro up rep re sen ting who le Af yon city filled, a qu es ti on na i re con sis ting of qu es ti ons abo ut de mog rap hic fe a tu res, SDB symptoms and con co mitant di se a ses. Body mass in di ces of the sub jects we re cal cu la ted. R Re e s su ul lt ts s: : The re was no sig ni fi cant dif fe ren ce for sno ring bet we en ma les and fe ma les, whe re as wit nes sed ap ne a and ex ces si ve day ti me sle e pi ness we re sig ni fi cantly hig her in fe ma les. Obe sity was mo re pre va lent among fe ma les. SDB symptoms we re mo re com mon among obe se sub jects. Di a be tes (DM), hyper ten si on (HT), hyper lipi de mi a and con ges ti ve he art fa i lu re (CHF) we re sig ni fi cantly mo re pre va lent among sno rers. There was a 1.7 folds in cre a se in HT risk and a 1.4 folds in cre a se in DM risk in sno rers. We al so fo und a 1.4 folds in cre a sed risk for hyper li pi de mi a and 2.1 folds in cre a sed risk for CHF in our sno rer popu la ti on. Sno ring and wit nes sed ap ne a we re fo und as risk fac tors for hyper ten si on in de pen dently from smo king sta tus, BMI and age. C Co on nc c l lu u s si i o on n: : The fre qu ency of SDB symptoms we re high in Afyon city, with a gre a ter than ex pec ted ra te for fe ma les. Sno ring and wit nes sed ap ne a we re fo und as in de pen dent risk fac tors for hyper ten si on.K Ke ey y W Wo or rd ds s: : Diabetes mellitus; hypertension; prevalence; sleep apnea syndromes; snoring Ö ÖZ ZE ET T A Am ma aç ç: : Türk eriş kin ler de uy ku da so lu num bo zuk lu ğu semp tom pre va lan sı nı sap ta mak ve bu semp tom lar ile eş lik eden sis te mik has ta lık lar ara sın da ki iliş ki yi in ce le mek. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : Tüm Af yon ili ni tem sil ede cek şekil de se çil miş ör nek lem gru bun da ki ki şi le re de mog ra fik özel likle ri, uy ku ile iliş ki li so lu num semp tom la rı ve eş lik eden has ta lık la rın sor gu lan dı ğı bir an ket dol durul du. Ka tı lım cı la rın be den kit le in deks le ri he sap lan dı. B Bu ul l g gu u l la ar r: : Er kek ve ka dın lar ara sın da hor la ma sık lı ğı açı sın dan is ta tis tik sel ola rak an lam lı fark sap tan maz ken, ta nık lı ap ne ve gün düz aşı rı uy kulu luk sık lı ğı ka dın lar da da ha sık ola rak bu lun du. Obe zi te ka dın lar da da ha sık idi. Obez has ta lar da uy ku da so lu num b...

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Section: Discussionsupporting

confidence: 48%

Section: Sta Tis Ti Cal Analy Sismentioning

confidence: 99%

Prevalence of Sleep Disordered Breathing Symptoms and Their Relation with Concomitant Diseases in Afyon, Turkey: A Population Based Study

Ünlü¹,

Sezer²,

Fidan³

et al. 2010

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

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“…Alternatively, the enlarged thyroid gland may have impaired the function of muscles attached to the hyoid bone, the anterior movement of which increases the patency of the hypopharynx and reduces UA resistance [9]. Finally, there may be a simple mass loading effect of the enlarged thyroid gland on the UA when the subject is supine during sleep [10].…”

Section: Discussionmentioning

confidence: 99%

Goitre: a cause of obstructive sleep apnoea in euthyroid patients

Deegan¹,

McNamara²,

Morgan³

1997

Eur Respir J

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Goitre: a cause of obstructive sleep apnoea in euthyroid patients. P.C. Deegan, V.M. McNamara, W.E. Morgan. ©ERS Journals 1997. ABSTRACT: While hypothyroidism is considered to predispose to obstructive sleep apnoea (OSA), the presence of a goitre itself is not a recognized cause of OSA.We present the cases of two euthyroid patients with large goitres and clinical evidence of OSA, whose OSA symptoms significantly improved following partial thyroidectomy.This finding suggests that the goitre contributed to their symptoms. Eur Respir J 1997; 10: 500-502 Hypothyroidism is viewed as a risk factor both for obstructive [1][2][3][4][5] and central [6,7] sleep apnoea. Replacement therapy with thyroxine usually leads to amelioration or even cessation of the associated apnoea. Proposed mechanisms linking the two conditions include: narrowing of the upper airway (UA) by deposition of mucopolysaccharides and protein extravasation into the tissues of the face, tongue and pharyngeal structures [1], dysfunction of UA dilator muscles due to hypothyroid myopathy [2,4], or abnormalities of ventilatory control [3,6]. However, little is known about whether an enlarged thyroid gland contributes to sleep-disordered breathing, with only one previous report of an acromegalic patient with obstructive sleep apnoea (OSA) and respiratory failure, who improved after thyroidectomy [7]. We present the cases of two euthyroid patients with large goitres and OSA requiring treatment with nasal continuous positive airway pressure (nCPAP). Case No. 1A 59 year old man, who presented after a gardening accident, was incidentally found to have a deviated trachea on examination and this was confirmed on chest radiography. Clinically, he was euthyroid and had no symptoms of UA obstruction. However, he had biochemical evidence of hyperthyroidism, with an elevated serum thyroxine (T 4 ) of 196 nmol·L -1 (reference range 53-135 nmol·L -1 ) and free T 4 index of 190 (reference range 59-127). A computerized tomographic (CT) scan of the neck and thoracic inlet revealed diffuse enlargement of the thyroid gland, especially of the left lobe, extending upwards to the hyoid arch and retrosternally down to the level of the aortic arch. Prior to surgery, the patient was made euthyroid with carbimazole. However, during follow-up, he reported excessive daytime sleepiness, with heavy snoring, grunting and gasping during sleep. Examination of his UA revealed a deviated nasal septum and a bulky uvula.On overnight oximetry, the patient had a total of 58 dips in arterial oxygen saturation (Sa,O 2 ) of ≥4% (7.4 episodes·h -1 ), the lowest being to 75%, and an obstructed pattern of breathing and heavy snoring on simultaneous video-recording. A diagnosis of clinically significant OSA was made. He had a further sleep study whilst on 7.5 cmH 2 O of nCPAP, with a subjective improvement in sleep quality, abolition of snoring and a reduction in the number of ≥4% dips in Sa,O 2 to a total of 11. After commencing nCPAP at home, he reported that he no longer snored, with more restful ...

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“…These alterations may accrue from adiposity around the pharynx and torso as follows. First, increases in neck circumference and fat deposited around the upper airway (12,72,(107)(108)(109) in obesity might narrow the upper airway. Second, upper airway collapsibility is higher in obese compared with nonobese individuals (25), and does not decrease appropriately when the pharynx is dilated by advancing the mandible anteriorly (110).…”

Section: Mechanical Effects Of Obesitymentioning

confidence: 99%

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

Schwartz

Patil²,

Laffan

et al. 2008

Proceedings of the American Thoracic Society

584

395

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Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity in Western society. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of obstructive sleep apnea. Obesity and particularly central adiposity are potent risk factors for sleep apnea. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system-acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue. These differences can produce alterations in the mechanical and neural control of upper airway collapsibility, which determine sleep apnea susceptibility. Although weight loss reduces upper airway collapsibility during sleep, it is not known whether its effects are mediated primarily by improvement in upper airway mechanical properties or neuromuscular control. A variety of behavioral, pharmacologic, and surgical approaches to weight loss may be of benefit to patients with sleep apnea, through distinct effects on the mass and activity of regional adipose stores. Examining responses to specific weight loss strategies will provide critical insight into mechanisms linking obesity and sleep apnea, and will help to elucidate the humoral and molecular predictors of weight loss responses.

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Effects of mass loading on the upper airway

Cited by 92 publications

References 0 publications

Prevalence of Sleep Disordered Breathing Symptoms and Their Relation with Concomitant Diseases in Afyon, Turkey: A Population Based Study

Prevalence of Sleep Disordered Breathing Symptoms and Their Relation with Concomitant Diseases in Afyon, Turkey: A Population Based Study

Goitre: a cause of obstructive sleep apnoea in euthyroid patients

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

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