What is the role of the larynx in adult obstructive sleep apnea?

Abstract

The endolarynx warrants consideration in the pathophysiology of OSA, particularly as it relates to sensory dysfunction and epiglottic obstruction. Patients with head and neck cancer of the laryngopharynx are at significant risk of OSA. Further research is needed to better understand and heighten awareness of the intimate role that the larynx may play in OSA.

Wilson's disease with and without rapid eye movement sleep behavior disorder compared to healthy matched controls

“…Only two patients with a slightly disabling WD had an OSAH syndrome with an AHI of >30/h, which most probably was caused by obesity (as Page 10 of 25 both had a BMI of >30 kg/m2). These results in patients with WD are in contrast to multiple system atrophy in which a high prevalence of dysarthria, nocturnal stridor, and OSAH have been observed [38,39] and to intracerebral hemorrhage with dysarthria in which an association to SDB has been reported [40].…”

Epiglottis collapse in adult obstructive sleep apnea: A systematic review

“…In the case of primary epiglottis collapse, CPAP may aggravate airway obstruction by further pushing the epiglottis down into the laryngeal inlet. Dedhia et al showed that the majority of adult patients who are unable to tolerate CPAP have multilevel obstruction, of which 15% presented with primary epiglottis obstruction of the hypopharynx …”

Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse

“…Some studies demonstrate that CPAP may be ineffective in patients who have a severely floppy epiglottis because the pressure may further push the epiglottis into the laryngeal inlet. [24][25][26] The extent to which epiglottic collapse contributes to CPAP failure or non-adherence is not known and is an area of interest for future study. Although surgical resection or trimming of the epiglottis may be an option, no controlled studies have reported the efficacy of this approach, and the potential for side effects such as aspiration are not trivial.…”