Role of dynamic sleep MRI in obstructive sleep apnea syndrome.

Abstract

To identify obstruction sites of the upper airway during sleep in patients with obstructive sleep apnea syndrome (OSAS) under dynamic conditions and improve knowledge to guide surgical treatment and advancements. The study included 15 patients (5 females and 10 males) who were diagnosed as having OSAS. Overall mean age was 40.2years (± 7.01years). All the patients underwent drug-induced sleep endoscopy (DISE) and dynamic sleep MRI. The presence, location, and direction of airway collapse were assessed. Dynamic MRI findings were correlated to DISE. Data of the site and direction of airway collapse were correlated with those of endoscopic findings and interobserver agreement was done. The dynamic images in sagittal section showed collapse of the upper airway at retropalatal level in 14 patients (93.33%) and at retroglossal level in seven patients (46.7%) and of these 14 patients; seven had combined retropalatal and retroglossal collapse. These findings were highly correlated with DISE findings with an excellent interobserver agreement for retropalatal and retroglossal levels (Kappa = 1 and 0.867, P value = 0.000), respectively. Objective measurements of the direction of collapse in axial dynamic sleep MRI images showed significant statistical correlation with endoscopic findings regarding retropalatal anteroposterior and circumferential collapse (Kappa = 0.58 and 0.52, P value = 0.02 and 0.03, respectively). Dynamic sleep MRI can reliably characterize the actual site of dynamic airway obstruction and has the potential of improving predictions of successful surgical outcomes in OSAS patients.