Cause Of Obstructive Sleep Apnea Research Articles

Retropharyngeal fibrolipoma: A counterchanging obstructive pattern in sleep apnea

Summary Retropharyngeal fibrolipoma has rarely been reported as the cause of obstructive sleep apnea (OSA). The clinical presentation, diagnosis, and treatment of tumor-related OSA are vastly different from those of generic OSA. We report a case of retropharyngeal fibrolipoma in a 17-year-old boy. Our patient presented with snoring, daytime sleepiness, and difficulty in swallowing. Flexible fiberoptic nasopharyngoscopy revealed a smooth bulging mass in the retropharynx. Magnetic resonance imaging demonstrated a hyperintense, heterogeneous mass over the retropharynx. Transoral excision of the retropharyngeal tumor was performed and pathological examination proved the tumor to be a fibrolipoma. The apnea/hypopnea index decreased from 12.2 to 7.4 event/h after surgery with associated improvement in snoring, daytime sleepiness, and swallowing. When swallowing difficulty occurs in patients with OSA, the retropharyngeal obstruction should be considered in evaluating the patient.

The Frequency of Lingual Tonsil Enlargement in Obese Children

Enlargement of the lingual tonsils is being increasingly recognized as a not uncommon and treatable cause of obstructive sleep apnea, particularly in patients with Down syndrome who have undergone palatine tonsillectomy and adenoidectomy. We have recognized an increasing number of patients who are obese and have obstructive sleep apnea with enlarged lingual tonsils. The purpose of this study was to evaluate the frequency of enlarged lingual tonsils in obese children. Seventy-one obese children (mean body mass index = 41.6 kg/m(2)) underwent sagittal fast spin-echo inversion recovery imaging. Lingual tonsils were identified and measured in the greatest anteroposterior diameter. Lingual tonsils > 10 mm were considered markedly enlarged. The subgroup with absent palatine tonsils (previous tonsillectomy) (n = 41) were compared with those with palatine tonsils present (n = 30). Forty-four (62%) of the obese children had measurable lingual tonsils, which is greater than the frequency previously reported in normal subjects (0%), subjects with obstructive sleep apnea (33%), or subjects with Down syndrome and obstructive sleep apnea (50%). Ten (14%) had lingual tonsils > 10 mm. Obese subjects with absent palatine tonsils (previous tonsillectomy) had a higher prevalence of measurable lingual tonsils than those with palatine tonsils (78% vs 22%, respectively; p < 0.001) and a higher prevalence of lingual tonsils > 10 mm (90% vs 10%, p < 0.001). Obese children have a high frequency of enlargement of the lingual tonsils with a significantly higher prevalence in those with previous tonsillectomy. Enlarged lingual tonsils may play a role in the pathogenesis of obstructive sleep apnea in obese children.

Discussion: Childhood Temporomandibular Joint Fracture Leading to Obstructive Sleep Apnea Syndrome

This is a very intriguing case presentation that clearly demonstrates the medical complications of maxillofacial trauma. Mandibular facture may be viewed as the principle factor in the etiology of this patient’s obstructive sleep apnea (OSA), including the comorbidity of daytime fatigue, hypertension, congestive heart failure, stroke, and early death. The acquired micrognathic mandible appears to impinge on the posterior airway space by the retro position of the tongue base. 1 Bettega G. Pepin J.L. Levy P. et al. Surgical treatment of a patient with obstructive sleep apnea syndrome associated with temporomandibular joint destruction by rheumatoid arthritis. Plast Reconstr Surg. 1998; 101: 1045 Crossref PubMed Scopus (14) Google Scholar Base of tongue obstruction is a well-recognized and clinically obvious cause of OSA. 2 Davies S.F. Iber C. Obstructive sleep apnea associated with adult-acquired micrognathia from rheumatoid arthritis. Am Rev Respir Dis. 1983; 127: 245 PubMed Google Scholar , 3 Pepin J.L. et al. Evaluation of the upper airway in sleep apnea syndrome. Sleep. 1992; 15: S50 PubMed Google Scholar From a teaching standpoint, many aspects are worthy of discussion, beginning with pediatric treatment of condylar fractures and extending through delayed orthognathic/prosthetic reconstruction, temporomandibular joint (TMJ) reconstruction, and management of OSA.

Obstructive Sleep Apnea Caused by Carotid Body Tumor: Case Report

Obstructive sleep apnea (OSA) results from a structural compromise of the upper airway combined with decrease in muscle tone during sleep. Overt upper airway pathology is rare, however a variety of pharyngeal tumors have been well described as a cause of OSA. We describe a case of a mass originating in the carotid body resulting in severe OSA with hypersomnia resistant to positive pressure ventilation.

Haemangioma of the Uvula causing Loud Habitual Snoring: A Rare Entity

Mucosal haemangiomas are unusual and typically involve frequently traumatised areas such as the lip, buccal mucosa and lateral borders of the tongue. Uvular haemangioma is rare and to our knowledge, has never been reported to cause obstructive sleep apnoea (OSA). We report an unusual case of uvular haemangioma causing loud habitual snoring and symptoms suggestive of OSA. This case report illustrates a rare cause of OSA and demonstrates the efficacy of surgery for obvious obstructive lesions of the pharynx.

Sleep apnea

To study clinical presentation of sleep disordered breathing (SDB) in children, their causative factors and response to treatment. A retrospective study of clinical data nd results of overnight polysomnography done at baseline and after therapy were reviewed in 56 patients under 18 years of age. Of the 56 patients included in the study 23(41%) cases were positive for SDB. 12 (52.1 %) patients had craniofacial abnormalities, 4 (17.3%) had neuromuscular and skeletal disorders, 2 (8.6%) had adenotonsillar hypertrophy, 1(4.3%) had bilateral vocal cord palsy and 3 (13%) had sleep apnoea associated with multisystemic disorders. Post-operative data showed improvement in all 6 cases of craniofacial abnormalities and both cases of adenotonsillar hypertrophy. Positive airway pressure treatment was useful in cases with obstructive sleep apnea (OSA) due to vocal cord palsy, thoracic scoliosis, systemic disorders and central hypoventilation. 41% of suspected cases were detected to have SDB. Craniofacial abnormality was the leading cause of OSA in the present study. Surgical correction improved symptoms apnea-hypopnea index (AHI) and desaturation in cases of craniofacial disorders and adenotonsillar hypertrophy. Vocal cord palsy, thoracic scoliosis, hypoventilation and systemic disorders associated OSA responded to positive airway pressure ventilation.

Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls

Cine MRI has become a useful tool in the evaluation of patients with persistent obstructive sleep apnea (OSA) despite previous surgical intervention and in patients with underlying conditions that render them susceptible to multilevel airway obstruction. Findings on cine MRI studies have also increased our understanding of the mechanisms and anatomic causes of OSA in children. To compare lingual tonsil size between children with OSA and a group of normal controls. In addition, a subanalysis was made of the group of children with OSA comparing lingual tonsils between children with and without underlying Down syndrome. Children with persistent OSA despite previous palatine tonsillectomy and adenoidectomy and controls without OSA underwent MR imaging with sagittal fast spin echo inversion-recovery images, and lingual tonsils were categorized as nonperceptible at imaging or present and measurable. When present, lingual tonsils were measured in the maximum anterior-posterior diameter. If lingual tonsils were greater than 10 mm in diameter and abutting both the posterior border of the tongue and the posterior pharyngeal wall, they were considered markedly enlarged. There were statistically significant differences between the OSA and control groups for the presence vs. nonvisualization of lingual tonsils (OSA 33% vs. control 0%, P=0.0001) and mean diameter of the lingual tonsils (OSA 9.50 mm vs. control 0.0 mm, P=0.00001). Within the OSA group, there were statistically significant differences between children with and without Down syndrome for the three lingual tonsil width categories (P=0.0070) and occurrence of markedly enlarged lingual tonsils (with Down syndrome 35% vs. without Down syndrome 3%, P=0.0035). Enlargement of the lingual tonsils is relatively common in children with persistent obstructive sleep apnea after palatine tonsillectomy and adenoidectomy. This is particularly true in patients with Down syndrome.

Pediatric obstructive sleep apnea: the year in review

In recent years several daytime symptoms resulting from pediatric obstructive sleep apnea have been recognized that affect neurobehavioral and cognitive functioning. It is important to identify patients who will benefit from treatment. Up until now the systematic analysis of obstructive sleep apnea in children has been hindered by both variable diagnostic criteria and patient care protocols. This review examines the effects of obstructive sleep apnea in children as well as treatment outcomes. Recent data suggest that some diagnostic modalities may underestimate the prevalence of sleep-disordered breathing in children. A review of the data from the past year shows a significant correlation between obstructive sleep apnea and daytime symptoms. It also shows mitigation of these symptoms with appropriate treatment. The directed history and physical examination continue to be the most effective means of diagnosis in most affected children. The polysomnogram is considered the gold standard for diagnosis but may underestimate the presence of sleep-disordered breathing in children. Some children with the diagnosis of primary snoring will benefit from treatment. In view of the profound effects of obstructive sleep apnea in children, it is vital to develop an accurate and universal system for diagnosing and treating these patients. Adenotonsillar hypertrophy is the major cause of obstructive sleep apnea in children. A directed history and physical examination followed by tonsillectomy and adenoidectomy are effective in improving the physical sequelae and quality of life of affected children.

Endoscopic findings in children with obstructive sleep apnea: Effects of age and hypotonia

Obstructive sleep apnea (OSA) syndrome is a common disorder among children and is often associated with significant morbidity. The causes of OSA are related to either fixed upper airway abnormalities such as adenotonsillar hypertrophy, or dynamic airway abnormalities such as laryngomalacia and pharyngeal wall collapse. The aim of the present study was to determine the prevalence of dynamic upper airway abnormalities, based on endoscopic findings, in normotonic and hypotonic children with polysomnographically documented OSA. The records of 39 consecutive children with OSA who underwent bronchoscopy (22 with normal tone, and 17 with hypotonia) were reviewed. The prevalence of dynamic defects among children with normal tone decreased with age. All 7 patients less than 1 year old had dynamic abnormalities (isolated or combined fixed/dynamic), compared to only 66% (6/9) of patients between 1-2 years old, and 17% (1/6) of children more than 2 years old. In contrast, dynamic abnormalities were very common among hypotonic children, independent of age. Since children with dynamic defects are less likely to respond to surgical treatments, it would be appropriate to identify these children prior to any intervention. Due to the higher frequency of dynamic defects in both infants (< 1 year) and hypotonic children, it may be appropriate to include endoscopy as part of the diagnostic evaluation of OSA in these subgroups.

Long-term follow-up and mechanisms of Obstructive Sleep Apnea (OSA) and related syndromes through infancy and childhood

Background: Although tonsil and adenoid (T&A) enlargement in children is a leading cause of it, Obstructive Sleep Apnea (OSA) may occur at any age. But even after T&A surgery, some children experience recurrent apneic episodes. The reasons for possible recurrence are unclear. Objective: To quantify the prevalence of recurrent OSA after T&A surgery and find out a common cause of OSA in children from the neonatal period to adulthood. Method: A retrospective report of apneic patients followed in a tertiary-care center is presented. Telephone interviews of parents were performed 3 years after T&A surgery. The questionnaire included night and day symptoms related to sleep-disordered breathing (SDB). A literature review was performed about associated causes of upper airway stenosis. Results: Out of 59 children who were included to follow up, 5 (8.5%) experienced residual or recurrent symptoms of SDB. The literature suggests the role of skeletal abnormalities in this process through nasal or pharyngeal stenosis. Major craniofacial anomalies are a well-known cause of obstruction. Thickened soft tissue has to be ruled out. Minor stenoses or neuromuscular disorders are less often diagnosed although they seem to be involved as well. Conclusion: A longitudinal follow-up of apneic children is able to reveal recurrence of SDB after adenotonsillectomy and often allows the understanding of mechanisms of upstream-induced recurrent pharyngeal obstructions.

Occult supraglottic lymphatic malformation presenting as obstructive sleep apnea

Sleep disordered breathing and obstructive sleep apnea is commonly encountered in the pediatric population. In many cases, it is the result of oropharyngeal obstruction secondary to adenoidal or adenotonsillar hypertrophy. We describe an unusual case of a child with adenoidal hypertrophy who had an occult supraglottic lymphatic malformation that manifested as obstructive sleep apnea. The management of this lesion is discussed including the use of endoscopy, carbon-dioxide laser, and the decision to avoid a tracheotomy. Occult supraglottic lymphatic malformations (LMs) are a rare cause of obstructive sleep apnea, the diagnosis of which will be missed without fiberoptic laryngeal examination. They are challenging to manage because of the airway involvement and propensity to recur.

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Tonsillar lymphoma as a cause of obstructive sleep apnea

Infrequently in adults, isolated lesions of the upper airway, larynx, and trachea can produce obstructive sleep apnea (OSA). We describe a case of OSA found to be caused by tonsillar lymphoma presenting as asymmetric tonsillar hypertrophy. Tonsillar lymphoma is rare, but can present as hypertrophied tonsils and/or adenopathy and lead to the development of OSA. This report emphasizes the importance of a thorough upper airway examination of all patients undergoing evaluation for OSA.

Acoustic rhinometry findings in patients with mild sleep apnea.

Nasal obstruction may contribute to the development of obstructive sleep apnea (OSA). Acoustic rhinometry (AR) measures nasal patency and congestion, which are useful parameters in objectively evaluating nasal obstruction. The nasal obstruction produced by allergic rhinitis may contribute to the development of OSA and can be easily assessed with AR. This study was undertaken to assess the degree of nasal obstruction seen in allergic patients with and without OSA. This study was a retrospective data analysis from a tertiary referral center. The AR data from 10 patients with and 40 patients without mild OSA were compared. The mean congestion factors at the first cross-sectional area (CSA1) on the AR graph were found to be significantly higher in the OSA group than in the non-OSA group (P = 0.03). The classification of change in congestion factors demonstrated significant differences at CSA1, CSA2, and CSA3 and in volume (t distributions <0.001, 0.0312, <0.001, and <0.001, respectively). The non-OSA patients noted a significant subjective improvement in nasal congestion after topical nasal decongestion, whereas the OSA patients did not (P <or= 0.0001 and 0.064, respectively). Although the role of nasal obstruction in OSA is controversial, our study lends evidence to the thought that the nasal obstruction associated with allergic rhinitis is associated with the presence of mild OSA. Whether allergic rhinitis is a direct cause of OSA is debatable, but we have shown that greater nasal congestion is related to the presence of OSA in a population of patients with allergic rhinitis.

Magnetic resonance imaging of the pharynx in OSA patients and healthy subjects.

Obstructive sleep apnoea (OSA) occurs because of recurrent narrowing and occlusion of the velopharynx (VP) during sleep. The specific cause of OSA is unknown. Cephalometric radiography, fibreoptic nasopharyngoscopy, acoustic reflection techniques, and computerized tomography have limitations (dynamic and tridimensional evaluation) in the mechanism of occlusion investigation. Static and dynamic examination of the soft tissue structures surrounding the upper airway during the respiratory cycle in wakefulness and sleep, can lead to a better understanding of the process. Ultrafast magnetic resonance imaging (one image per 0.8 s) was used to study the upper airway and surrounding soft tissue in 17 patients with OSA during wakefulness and sleep, and in eight healthy subjects whilst awake. The major findings of this investigation in the 25 subjects were as follows: 1) the VP was smaller in apnoeic patients, only during part of the respiratory cycle; 2) the variation in VP area during the respiratory cycle was greater in apnoeic patients than in controls, particularly during sleep, suggesting an increased compliance of the VP in these patients; 3) VP narrowing was similar in the lateral and anterior-posterior dimensions, both in controls and apnoeic patients while awake; apnoeic patients during sleep have a more circular VP upon reaching the minimum area; 4) there was an inverse relationship between dimensions of the lateral pharyngeal walls and airway area, probably indicating that lateral walls are passively compressed or stretched as a result of changes in the airway calibre; and 5) soft palate and parapharyngeal fatpads were larger in apnoeic patients, although their role in the genesis of OSA is uncertain. It was concluded that changes in the velopharynx area and diameter during the respiratory cycle are greater in apnoeic patients than in normal subjects, particularly during sleep. This suggests that apnoeic patients have a more collapsible velopharynx, this being the main mechanism of obstruction.

Serum Leptin and Vascular Risk Factors in Obstructive Sleep Apnea

To define the metabolic profile relevant to vascular risks in obstructive sleep apnea (OSA) and the role of leptin resistance in this risk profile. Case control study. Sleep Laboratory, Queen Mary Hospital, University of Hong Kong, China. Thirty OSA subjects were matched with 30 non-OSA subjects for body mass index (BMI), age, sex, and menopausal status. Neck, waist, and hip girth, skinfold thickness, and fasting serum levels of lipids, glucose, insulin, and leptin were compared between these two groups. Compared with control subjects with a similar BMI but without OSA, the OSA group had a significantly more adverse vascular risk factor profile, including dyslipidemia, higher diastolic BP, insulin resistance, and greater adiposity reflected by skinfold thickness. OSA subjects also had higher circulating leptin levels (9.18+/-4.24 ng/mL vs 6.54+/-3.81 ng/mL, mean +/- SD, p = 0.001). Serum leptin levels correlated positively with BMI, skinfold thickness, serum cholesterol, low-density lipoprotein cholesterol, insulin, insulin/glucose ratio, apnea-hypopnea index, and oxygen desaturation time; multiple stepwise regression analysis identified skinfold thickness, waist/hip ratio, serum low-density lipoprotein cholesterol, and diastolic BP as independent correlates, while only serum insulin and diastolic BP were independent correlates in OSA subjects. After treatment with nasal continuous positive airway pressure for 6 months, there was a significant decrease in circulating leptin (p = 0.01) and triglyceride levels (p = 0.02) without change in other parameters. Despite controlling for BMI, OSA subjects showed distinct profiles with clustering of vascular risk factors. Hyperleptinemia was present in the OSA subjects, but it can be normalized by treatment with nasal continuous positive airway pressure, suggesting that increased leptin resistance was not the cause of OSA or its associated vascular risks.

Impact of brainstem sleep mechanisms on pharyngeal motor control

Suppression of respiratory muscle activity in sleep, particularly evident in the pharyngeal muscles, is pivotal to the pathogenesis of common sleep-related breathing disorders such as obstructive sleep apnea. Obstructive apneas are caused by sleep-related decrements in pharyngeal muscle activity that leads to snoring and airway obstruction in individuals with underlying structural narrowing of the upper airway. Since obstructive apneas occur exclusively during sleep, this disorder by definition is state-dependent and ultimately caused by the influences of brainstem sleep mechanisms on pharyngeal motoneurons in individuals with compromised upper airway anatomy. This paper reviews the central neuronal mechanisms by which sleep reduces the output to the pharyngeal muscles and the neurotransmitters implicated in this alteration. The experimental approaches used to address this problem are also mentioned and their relative advantages and disadvantages discussed. In particular, the information derived from reduced animal preparations is reviewed and the need for studies in natural sleep is emphasised. Identifying the central neuronal mechanisms and neurotransmitters involved in sleep-related suppression of pharyngeal muscle activity not only has important basic relevance to understanding state-dependent respiratory control, it also has immediate clinical relevance to understanding common sleep-related breathing disorders at the central neuronal level. Determining these basic mechanisms also has immediate clinical relevance to understanding the pathogenesis of airway occlusions, and guiding neuro-pharmacological approaches aimed at preventing the sleep-related decrements in pharyngeal muscle tone that are ultimately the root cause of obstructive sleep apnea.

Successful Treatment of Obstructive Sleep Apnea With Use of Nasal Continuous Positive Airway Pressure in Three Patients With Mucosal Hemangiomas of the Oral Cavity

Cysts and benign tumors are uncommon causes of obstructive sleep apnea (OSA), and surgical removal is usually favored. In patients in whom an operation poses a high risk, however, nasal continuous positive airway pressure (CPAP) may prove beneficial. We describe three patients with hemangiomas of the oral cavity in whom polysomnography revealed moderate to severe OSA. In all three patients, nasal CPAP effectively decreased sleep-related disordered breathing events and dramatically improved their sleep. To our knowledge, this is the first report of OSA associated with hemangiomas involving the upper airway. Our experience suggests that nasal CPAP therapy is effective and well tolerated in such patients.

Obstructive Sleep Apnea Due to Endogenous Testosterone Production in a Woman

Obstructive sleep apnea (OSA) is a common condition characterized by snoring, recurrent episodes of cessation of breathing (obstructive apneas), disrupted sleep, and excessive daytime somnolence. Associated serious complications are hypertension, increased risk of heart disease, stroke, and increased susceptibility to industrial and motor vehicle accidents. OSA is considerably more common in men than in women. In postmenopausal women, the incidence of OSA increases. These factors suggest that reproductive hormones have a role in the cause of OSA. Treatment with testosterone has been reported to cause OSA in men, and exogenous androgen administration has been reported to cause OSA in one woman. In a review of the English literature, we found no previous reports of OSA that was induced by endogenous testosterone in women. Herein we describe a nonobese 70-year old woman with clinically significant OSA and a benign testosterone-producing ovarian tumor. After successful removal of the tumor, her OSA resolved, and her testosterone level normalized. This unique case supports the theory of male hormonal (testosterone) influence in the OSA syndrome.

Antrochoanal polyp-a cause of obstructive sleep apnoea in children.

Obstructive sleep apnoea syndrome is a well established entity which has received much attention in the recent past. In children the commonest cause of sleep apnoea is adenotonsillar hypertrophy. We report two cases of antrochoanal polyp in children who presented with symptoms consistent with sleep apnoea. Preoperative polysomnography was performed in these cases which confirmed the diagnosis of sleep apnoea. Under general anaesthesia both children underwent polypectomy with middle meatal antrostomy Post operatively the patients were put on steroid nasal spray for 2 weeks. Repeat polysomnograpy performed four weeks following surgery revealed reversal ot disturbed sleep patterns.