The Shape of the Epiglottis Reflects Improvement in Upper Airway Obstruction after Weight Loss

Abstract

Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent episodes of closure of the upper airway during sleep, and is highly prevalent among overweight individuals. A significant percentage of patients with OSA remain undiagnosed. This condition creates chronic nighttime hypoxemia that can result in significant complications including systemic and pulmonary hypertension, cor pulmonale, and stroke. Polysomnography is still the most widely used method for diagnosing OSA. Studies have shown that in the majority of patients with OSA the airway obstruction involves the retroglossal region. Upon performing esophagogastroduodenoscopy on patients with a wide range of body mass indices (from 21 to 63), we noticed a gradual increase in the concavity of the posterior epiglottal surface as the BMI increases. Upon following some of the patients who underwent laparoscopic gastric banding and lost significant weight, we noticed a dramatic change in the shape of the epiglottis. This reflects a relief in the pressure on the epiglottis created by the collapsing airways in periods of apnea. Thus, the deformity in the shape of the epiglottis reflects the chronic airway collapse in obese patients, and improvement in this deformity after weight loss indicates a relief of the chronic upper airway obstruction.

Obesity and Obstructive Sleep Apnea-Hypopnea Syndrome: the Impact of Bariatric Surgery

“…38 Fatty deposition results in airway reduction and predisposes to airway collapse, contributed to by neurologic loss of the normal dilator muscle tone in the neck. The pressure of the parapharyngeal fat pads contributes to the collapse of the retroglossal space during sleep.…”

Obstructive Sleep Apnea–Hypopnea Syndrome—The Role of Bariatric and Maxillofacial Surgeries

“…Surgical treatment, in addition, is the only intervention proven to maintain weight reduction in severely obese patients for the longer term (over 10 years). Improvement in OSAHS symptoms with reduction in AHI in severely obese patients after bariatric surgery has been well-documented [2,[5][6][7]33].…”

“…The pressure of the soft tissues surrounding the pharynx, particularly the parapharyngeal fat pads, results in chronic collapse of the retroglossal airway and even deforms the epiglottis shape [33]. In morbidly obese patients, the oropharynx is the weakest area of the upper airway rather than the retropharyngeal space and uvula, as shown in a computed tomographic cross-sectional area of the upper airway [7].…”

Preoperative Cardiac and Pulmonary Assessment in Bariatric Surgery

“…Morbidly obese patients have increased morbidity and mortality [11] related to a high prevalence of cardio-respiratory diseases, which may be known or unknown at the time of surgery. They include obstructive sleep apnea-hypopnea syndrome (OSAHS) [12][13][14], restrictive pulmonary syndrome, cardiac failure, coronary heart disease, and prolongation of the QT interval [15][16][17]. The present study aimed to assess the prevalence of these associated morbidities, and the value of cardiopulmonary investigations routinely performed in a single cohort of patients, candidates for bariatric surgery.…”