The role of upper airway morphology in apnea versus hypopnea predominant obstructive sleep apnea patients: an exploratory study

Özer, Tülay; Selçuk, Adın; Yılmaz, Zahide; Voyvoda, Nuray; Çam, İsa; Özel, Halil Erdem; Özdoğan, Fatih; Esen, Erkan; Genç, Gülsüm Aydan; Genç, Selahattin

doi:10.1259/bjr.20170322

Cited by 8 publications

(10 citation statements)

References 16 publications

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“…AI, apnea index; AHI, apnea-hypopnea index; HI, hypopnea index previous study evaluating the upper airway morphology by computed tomography scans reported that the apnea-predominant group showed lesser minimal anteroposterior/lateral dimensions and crosssectional area of the velopharynx than the hypopnea-predominant group. 19 However, velopharynx airway volume was not associated with the apnea or hypopnea predominance in that study. 19 In the current study, we found that preoperative tonsil grade and MMP scores were not different between the two groups.…”

Section: Postoperative Complicationscontrasting

confidence: 50%

“…19 However, velopharynx airway volume was not associated with the apnea or hypopnea predominance in that study. 19 In the current study, we found that preoperative tonsil grade and MMP scores were not different between the two groups. Given that the upper airway dynamically collapses during sleep in patients with OSA, further studies using drug-induced sleep endoscopy would help clarify the difference in the dynamic airway closure patterns between the two groups.…”

Section: Postoperative Complicationscontrasting

confidence: 50%

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Comparison of clinical features and surgical outcomes between hypopnea‐ and apnea‐predominant obstructive sleep apnea

Rha

Jeong

Al-Yahya

et al. 2022

Clinical Otolaryngology

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Objectives This study is aimed to investigate the differences in the clinical features and surgical outcomes between hypopnea‐ and apnea‐predominant obstructive sleep apnea (OSA). Design Cohort study. Setting Single tertiary care centre. Participants This study included 190 patients with OSA who underwent multilevel upper airway surgery between September 2012 and September 2021. The patients were divided into two groups according to the proportion of each respiratory event: hypopnea‐predominant (n = 102) and apnea‐predominant (n = 88). Main Outcome Measures The primary outcome measure was the percentage improvement in the apnea‐hypopnea index (AHI) from baseline AHI after surgery. Results The apnea‐predominant group included more male patients and had higher AHI, respiratory disturbance index (RDI) and oxygen desaturation index (ODI) than the hypopnea‐predominant group. Both groups showed significant improvements in AHI, apnea index, RDI, supine AHI, REM AHI, non‐REM AHI, ODI, lowest O2 saturation and Epworth Sleepiness Scale scores following the surgery. Notably, hypopnea index increased after surgery in the apnea‐predominant OSA group. Although the improvement in the absolute value of AHI by surgery was significantly greater in the apnea‐predominant group than in the hypopnea‐predominant group, the two groups showed no significant difference in the percentage improvement in AHI from baseline AHI. Conclusion Patients with apnea‐predominant OSA had more severe disease than those with hypopnea‐predominant OSA; however, surgical outcomes, as evaluated by percentage AHI improvement, were comparable between the two groups. In addition, multilevel upper airway surgery may induce the transition from apnea to hypopnea in patients with apnea‐predominant OSA.

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Section: Postoperative Complicationscontrasting

confidence: 50%

Section: Postoperative Complicationscontrasting

confidence: 50%

Comparison of clinical features and surgical outcomes between hypopnea‐ and apnea‐predominant obstructive sleep apnea

Rha

Jeong

Al-Yahya

et al. 2022

Clinical Otolaryngology

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“…Anatomically, Ozer et al evaluated OSA patients with both apnea- and hypopnea-predominance compared to non-snoring controls using computerized tomography (CT) scans [11]. They found the measurements of the soft palate were similar for both OSA groups and significantly smaller than controls.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Significance of Apneas Versus Hypopneas: Is There Really a Difference?

Spector¹,

Loriaux²,

Farjat³

2019

Cureus

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Introduction Obstructive sleep apnea is diagnosed by identifying obstructive apneas and hypopneas, but no study has shown that it is necessary to distinguish these events from each other. Our goal was to analyze results from polysomnograms to determine if adverse health outcomes were more likely in patients with higher apnea indices relative to their hypopnea indices. Our hypothesis was that scoring apneas separately from hypopneas has no predictive value. Methods A retrospective case series was performed for consecutive diagnostic and split-night polysomnograms with apnea-hypopnea indices greater than five per hour. Clinical data reviewed included the presence of cardiovascular diseases, hypertension, depression, and migraine. Both univariate and multivariate analyses were performed to look for correlations between polysomnographic indices and the comorbidities. Results Three hundred fifty-one records were included. Univariate analysis showed no significant difference between the apnea index (AI) and hypopnea index (HI) based on the presence of any of the comorbidities. Multivariate logistic regression also indicated no significant association between indices and comorbidities, aside from one statistically significant correlation between a higher HI and depression. Conclusions Clinical comorbidities are no more likely in patients with higher apnea indices than hypopnea indices. While apneas are considered a more severe form of obstruction, this distinction does not have any known clinically predictive value. This finding raises the question as to whether scoring hypopneas and apneas as different events on polysomnograms is necessary or helpful. Scoring apneas and hypopneas as “obstructions” could save resources and increase inter-scorer reliability.

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“…However, UA total area was significantly correlated with AHI improvement with treatment and is considered a factor that may influence OSA treatment and outcomes with MAD. While previous studies [54,55] reported correlations between airway linear, area and/or volume measurements, and AHI severity at baseline, Svaza et al [55] utilized only 2D measurements, Abramson et al [31] did not standardize head position during or after image acquisition, and Ozer et al [54] utilized CT scans taken in the supine position. For these reasons, the findings of those studies are not directly comparable to the present study results.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes

et al. 2021

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Objectives This study aims to assess craniofacial dimensions in obstructive sleep apnea (OSA) patients treated with a mandibular advancement device (MAD) and to identify anatomic influences on OSA severity and MAD therapy outcomes. Materials and methods Twenty patients with OSA were prospectively treated with MAD. Clinical, cone-beam computed tomography, and polysomnography exams were performed before treatment and 4-6 months after achieving the MAD therapeutic position. Polysomnographic exams and three-dimensional maxillary, mandibular, and upper airway (UA) measurements were evaluated. Pearson's correlation and t-tests were applied. Results Before MAD treatment, the transverse width measured at the frontomaxillary suture and the angle between the mandibular ramus and Frankfurt horizontal were statistically correlated with apnea and the hypopnea index (AHI), while the gonial angle was correlated with therapeutic protrusion. After MAD treatment, all patients showed a significant AHI reduction and an improvement in minimum oxyhemoglobin saturation. The UA total volume, superior and inferior oropharynx volume, and area were statistically correlated with MAD therapeutic protrusion. The UA total area showed a statistical correlation with the improvement in AHI, and the superior oropharynx volume and area increased significantly. Conclusions The transversal frontomaxillary suture width and the mandibular ramus facial angle may influence OSA severity. The gonial angle, volume, and area of all UA regions may indicate the amount of protrusion needed for successful MAD treatment. Clinical relevanceThe craniofacial characteristics reported as important factors for OSA severity and MAD treatment outcomes impact therapy planning for OSA patients, considering individual anatomic characteristics, prognosis, and cost benefits.

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The role of upper airway morphology in apnea versus hypopnea predominant obstructive sleep apnea patients: an exploratory study

Cited by 8 publications

References 16 publications

Comparison of clinical features and surgical outcomes between hypopnea‐ and apnea‐predominant obstructive sleep apnea

Comparison of clinical features and surgical outcomes between hypopnea‐ and apnea‐predominant obstructive sleep apnea

The Clinical Significance of Apneas Versus Hypopneas: Is There Really a Difference?

Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes

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