Role of ultrasonography in assessment of anatomic upper airway changes in patients with obstructive sleep apnea.

Sabah Hussein,Khaled Mahmoud Kamel,Marwa Moawad Shaban,Emad Efat Abd El-Hamid,Safy Zahid Kaddah

doi:10.5603/arm.a2020.0187

Sabah Hussein, Khaled Mahmoud Kamel + Show 3 more

Open Access

https://doi.org/10.5603/arm.a2020.0187

Copy DOI

Abstract

This study assessed the role of ultrasonography in detecting the level and degree of obstruction of airway passages in patients with obstructive sleep apnea (OSA) and its relation to OSA severity. It included thirty-three patients diagnosed as OSA, and ten healthy subjects as a control group. All participants were ≥ 18 years and were subjected to full medical history, Epworth sleepiness score (ESS), thorough clinical examination, complete overnight polysomnography and neck ultrasonography. Ultrasonography findings showed a statistically significant increase in lateral parapharyngeal wall thickness (LPWT) (P < 0.001) and a significant increase in distance between lingual arteries (DLA) (P < 0.01) among OSA patients. Moreover, there was a significant statistical decrease in the retropalatal pharynx transverse diameter (RPD) (P < 0.05) in the OSA group compared to those without OSA. LPWT and DLA are parameters that can be used to predict the severity of OSA. Combination of LPWT and RPD can achieve a 100% sensitivity and specificity. Ultrasound is more objective and convenient than the questionnaire because it doesn't require overnight time consumption. It is also more relevant than pulse oximetry for examining pharyngeal airspace. Also, this study demonstrated that submental ultrasonography is sufficiently sensitive for differentiating OSA severity.

Highlights

Obstructive sleep apnea is a common disorder, characterized by recurrent narrowing and closure of the upper airway accompanied by intermittent oxyhemoglobin desaturation and sympathetic activation
Diagnosis of obstructive sleep apnea (OSA) can be indicated by symptomatology and the presence of known risk factors such as increasing age, obesity and large neck circumference, OSA can occur in individuals with none of these risk factors [1]
The group 1 included OSA patients (n = 33): 15 males (45.5%) and 18 females (54.5%), their age range was 39–75 years with mean ± SD of 57.76 ± 7.84 years, their body mass index (BMI) ranged from 28.10 to 66.10 kg/m2 with mean ± SD of 43.30 ± 10.11 kg/m2. They were subdivided according to polysomnography results into mild OSA (5 ≤ apnea–hypopnea index (AHI) < 15) patients (9/33, 27.2%), Moderate OSA (15 ≤ AHI < 30) patients (12/33, 36.4%) and Severe OSA (AHI ≥ 30) patients (12/33, 36.4%)

Summary

Introduction

Obstructive sleep apnea is a common disorder, characterized by recurrent narrowing and closure of the upper airway accompanied by intermittent oxyhemoglobin desaturation and sympathetic activation. Diagnosis of OSA can be indicated by symptomatology and the presence of known risk factors such as increasing age, obesity and large neck circumference, OSA can occur in individuals with none of these risk factors [1]. A number of tools and methods are available for the assessment of sleep health as self-reported questionnaire instruments. The gold standard for diagnosis of OSA is the overnight polysomnography [2]. Inexpensiveness, no radiation exposure and office-based procedure, an increasing number of physicians uses ultrasonography (US) to examine the neck. Airway ultrasound can visualize and assess the mouth

Methods

Results

Conclusion