The value of the pharyngeal airway pressure monitoring test in topodiagnosis of OSA

Abstract

Objective:To analyses the value of an improved methods of Muller's test, pharyngeal airway pressure monitoring test（PAPMT）, in topodiagnosis of OSA. Method:One hundred and one cases with OSA（AHI≥5 times per hour） and 30 normal adults were included in the study. Under the pressure monitoring, the electronic laryngoscope were stayed at the palatopharyngeal and glossopharyngeum. First, observe the maximum expiratory pressure and the minimum spiratory pressure. And then measure and record changes of pharynx cross-sectional area at palatopharyngeal and glossopharyngeum under the different pressure. At Last, analyses the correlation between changes of Pharynx cross-sectional area with polysomnography（PSG）. Result:①In 101 cases with OSA, the maximal inspiratory pressure of Müller's manerver distribution is between 1 and 8 kPa. ②The changes of pharynx cross-sectional area of OSA at palatopharyngeal and glossopharyngeum is significantly greater than the control group, and there were obvious differences between OSA and the control group. ③In OSA group, the plug rate at palatopharyngea was 96% and the plug rate at glossopharyngeum is 34% at the minimum pressure. There are no cases have pharynx jams at the control group. ④The main cause of the palatopharyngeal obstruction was strictures in left and right（73%）, and the anatomical factors causing obstruction mainly were, thicken of the pharyngeal wall. The main cause of the hypopharyngeal obstruction was strictures in front and back（71%）, and the redundant lymph tissue at tongue base and posterior displacement of the tongue base, and collapse of pharyngeal wall played an important role at tongue-pharyngeal obstruction. ⑤The changes of pharynx cross-sectional area at palatopharyngeal and glossopharyngeum when the pressure is ±4 kPa is greater than when the pressure is ±2 kPa. ⑥When the pressure is ±2 kPa, The changes of pharynx cross-sectional area at palatopharyngeal is greater than at glossopharyngeum. ⑦Diminished pharyngeal apertures and collapsibility were associated with increased rates of apnea and hypopnea index and the suction pressure（P<0.05）. Conclusion:①PAPMT is able to measure and calculate the changes of pharynx cross-sectional area, determine the site of obstruction, and help the treatment. ②The primary site of obstruction is at velopharyngeal in OSA group. ③The changes of pharynx cross-sectional area at palatopharyngeal and glossopharyngeum of patients can reflects the severity of the OSA.