Peripheral neuropathology of the upper airway in obstructive sleep apnea syndrome

Tsai, Yi Ju; Ramar, Kannan; Liang, Yao Jen; Chiu, Po Han; Powell, Nelson B.; Chao, Yun; Lung, Tzu Chen; Lin, Wesley Wen-Yang; Tseng, Po Jung; Wu, Ming; Chien, K.; Weaver, Edward M.; Lee, Fei Peng; Lin, Chia Mo; Chen, Kuang Chao; Chiang, Rayleigh Ping Ying

doi:10.1016/j.smrv.2012.05.005

Cited by 21 publications

(18 citation statements)

References 93 publications

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“…Thus, there is a large body of evidence that UA neuromuscular abnormalities are frequent in OSAS patients, and these altogether support the neurogenic theory of OSAS [5][6][7]34]. In recent years, multiple studies have demonstrated altered UA sensory input and abnormal UA motor function in patients with OSAS using a variety of neurophysiological and histological approaches [5,7,[35][36][37], and impaired neural function is at least partly reversible with treatment for sleep apnea [27].…”

Section: The Neurological Theory Of Osas and The Upper Airways Remodementioning

confidence: 93%

“…Two primary theories have been proposed to explain the pathophysiology of OSAS: the obstructive theory, in which muscle hypertrophy leads to airway narrowing, and the neurogenic theory, which postulates that peripheral nerve degeneration due to vibratory stretch trauma, or systemic diseases, lead to muscle atrophy and collapse [5][6][7]. A progressive local neurogenic lesion caused by repeated microtrauma of snoring might be a potential contribution factor for UA collapsibility [8].…”

Section: Introductionmentioning

confidence: 99%

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Nerve and Muscle Changes in the Upper Airways of Subjects with Obstructive Sleep Apnea: Structural Basis for the Neurogenic Theory

Cobo¹,

Macías²,

Alvarez³

et al. 2017

Sleep Apnea - Recent Updates

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Obstructive sleep apnea syndrome (OSAS) is a widely diffused disease associated with specific genetics, age, gender, craniofacial and upper airways anatomy, obesity, and endocrine conditions, but not with ethnicity profiles. The so-called neurogenic neurogenic theory of OSAS postulates that the collapse of the upper airways that characterize this disease is due to peripheral nerve degeneration that leads to muscle atrophy and collapse. This review attempts to summarize the structural and functional changes in both the sensory and motor innervation of the walls of the upper air ways in patients suffering from OSAS.

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Section: The Neurological Theory Of Osas and The Upper Airways Remodementioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Nerve and Muscle Changes in the Upper Airways of Subjects with Obstructive Sleep Apnea: Structural Basis for the Neurogenic Theory

Cobo¹,

Macías²,

Alvarez³

et al. 2017

Sleep Apnea - Recent Updates

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“…In the era of the mini-invasive/conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS [5], with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, are we still allowed to propose the resection of palatal/pharyngeal muscles and uvula?…”

Section: Dear Editormentioning

confidence: 99%

“…The role of the excessive collapsibility of the lateral pharyngeal walls has become increasingly considered in the genesis of retropalatal OSAS [5]. Therefore the recent evolution of OSAS surgery has been focusing on the goal of obtaining the expansion and stabilization of the pharyngeal airspace through the reduction of the lateral pharyngeal walls collapsibility, rather than through the ablation of the ''redundant'' palato-pharyngeal soft tissues [6].…”

Section: Dear Editormentioning

confidence: 99%

“…Furthermore this ''resective'' technique, in which the uvula, part of the soft palate and lateral pharyngeal walls are excised, is associated with long-term side-effects (velopharyngeal insufficiency, dysphagia, persistent dryness, globus sensation, voice changes, nasopharyngeal stenosis) persisting after UPPP in 58 % of the patients [2]. Due to resulting leaks and mouth dryness, UPPP is also considered as a risk factor for CPAP non-compliance.In the era of the mini-invasive/conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS [5], with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, are we still allowed to propose the resection of palatal/pharyngeal muscles and uvula?…”

mentioning

confidence: 99%

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Should We Stop Performing Uvulopalatopharyngoplasty?

Mantovani

Rinaldi

Salamanca³

et al. 2014

Indian J Otolaryngol Head Neck Surg

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Uvulopalatopharyngoplasty (UPPP) is still one of the most frequently performed procedures for snoring and obstructive sleep apnea syndrome (OSAS) in adults, with unsatisfactory results. In the era of the mini-invasive/ conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS, with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, we believe that we should re-evaluate the role of these procedures involving the resection of palatal/pharyngeal muscles and uvula.We read with great interest the recent article from Baradaranfar et al. [1] describing the effectiveness of uvulopalatopharyngoplasty (UPPP) in treatment of patients with obstructive sleep apnea syndrome (OSAS). This paper gave us the impetus to reflect about UPPP, which is one of the most frequently performed procedures for snoring and OSAS in adults with retro-palatal obstruction, although reported results of UPPP are not brilliant [1,2]. UPPP has a reported success rate of approximately 40-60 % for improving mild to moderate OSA [3]. Värendh et al. reported that almost 50 % of patients operated with UPPP are not satisfied with the result of the operation after 20 years, and one-third uses CPAP at the follow-up [4]. Furthermore this ''resective'' technique, in which the uvula, part of the soft palate and lateral pharyngeal walls are excised, is associated with long-term side-effects (velopharyngeal insufficiency, dysphagia, persistent dryness, globus sensation, voice changes, nasopharyngeal stenosis) persisting after UPPP in 58 % of the patients [2]. Due to resulting leaks and mouth dryness, UPPP is also considered as a risk factor for CPAP non-compliance.In the era of the mini-invasive/conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS [5], with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, are we still allowed to propose the resection of palatal/pharyngeal muscles and uvula?The role of the excessive collapsibility of the lateral pharyngeal walls has become increasingly considered in the genesis of retropalatal OSAS [5]. Therefore the recent evolution of OSAS surgery has been focusing on the goal of obtaining the expansion and stabilization of the pharyngeal airspace through the reduction of the lateral

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Sensory Innervation of the Human Soft Palate

Chen

et al. 2018

The Anatomical Record

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The human soft palate plays an important role in respiration, swallowing, and speech. These motor activities depend on reflexes mediated by sensory nerve endings. To date, the details of human sensory innervation to the soft palate have not been demonstrated. In this study, eight adult human whole-mount (soft palate-tongue-pharynx-larynx-upper esophagus) specimens were obtained from autopsy. Each specimen was bisected in the midline, forming two equal and symmetrical halves. Eight hemi-specimens were processed with Sihler's stain, a whole-mount nerve staining technique. The remaining eight hemi-soft palates were used for immunohistochemical study. The soft palatal mucosa was dissected from the oral and nasal sides and prepared for neurofilament staining. Our results showed that the sensory nerve fibers formed a dense nerve plexus in the lamina propria of the soft palatal mucosa. There was a significant difference in the innervation density between both sides. Specifically, the oral side had higher density of sensory nerve fibers than the nasal side of the soft palate. The mean number and percent area of the sensory nerve fibers in the mucosa of the nasal side was 78% and 72% of those in the mucosa of the oral side, respectively (P < 0.0001). The data presented here could be helpful for further investigating the morphological and quantitative alterations in the sensory nerves in certain upper airway disorders involving the soft palate such as obstructive sleep apnea (OSA) and for designing effective therapeutic strategies to treat OSA. Anat Rec, 301:1861-1870, 2018. © 2018 Wiley Periodicals, Inc.

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Peripheral neuropathology of the upper airway in obstructive sleep apnea syndrome

Cited by 21 publications

References 93 publications

Nerve and Muscle Changes in the Upper Airways of Subjects with Obstructive Sleep Apnea: Structural Basis for the Neurogenic Theory

Nerve and Muscle Changes in the Upper Airways of Subjects with Obstructive Sleep Apnea: Structural Basis for the Neurogenic Theory

Should We Stop Performing Uvulopalatopharyngoplasty?

Sensory Innervation of the Human Soft Palate

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