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European Archives of Oto-Rhino-Laryngology

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17-11-2023 | Sleep Apnea | Miscellaneous

Analysis of the cause of retrolingual obstruction in patients with moderate–severe obstructive sleep apnea

Authors: Wanting Gao, Lei Shi, Dengxiang Xing, Jie Qin, Chenhai Zheng, Shuhua Li, Dahai Wu

Published in: European Archives of Oto-Rhino-Laryngology | Issue 2/2024

Abstract

Purpose

To evaluate the percentage of obstructive sleep apnea (OSA) patients with retrolingual obstruction in all moderate–severe OSA patients and the proportions of different causes in all moderate–severe OSA patients with retrolingual obstruction and to discuss the accuracy of the Friedman tongue position (FTP) and retrolingual cross-sectional area (RCSA) in assessing the retrolingual obstruction.

Methods

Two hundred and twenty moderate–severe OSA patients were enrolled. After retrolingual obstruction was diagnosed, the percentage of OSA patients with retrolingual obstruction in all moderate–severe OSA patients was calculated. After that, the different causes of retrolingual obstruction were diagnosed based on different diagnostic criteria, and the proportions of different causes in all moderate–severe OSA patients with retrolingual obstruction were calculated. Finally, the correlations between FTP, RCSA, and apnea–hypopnea index after nasopharyngeal tube insertion (NPT-AHI) were analyzed, and the proportions of different causes of retrolingual obstruction based on different FTP and RCSA were observed.

Results

There were 128 patients with retrolingual obstruction, accounting for 58.2% of all moderate–severe OSA patients. In 128 patients with retrolingual obstruction, the proportions of glossoptosis (48.4%), palatal tonsil hypertrophy (28.1%), and lingual hypertrophy (8.6%) were relatively high. Both FTP and RCSA did not correlate with NPT-AHI. The proportion of lingual hypertrophy increased gradually with the increase of FTP and the proportions of glossoptosis in all FTP classifications were high. The patients with RCSA > 180 mm² were mainly affected by glossoptosis and palatal tonsil hypertrophy, while patients with RCSA ≤ 180 mm² were mainly affected by lingual hypertrophy.

Conclusion

The percentage of patients with retrolingual obstruction in all moderate–severe OSA patients is relatively high, mainly glossoptosis, palatal tonsil hypertrophy, and lingual hypertrophy. FTP classification and RCSA can only reflect the retrolingual anatomical stenosis, but cannot fully reflect the retrolingual functional stenosis, especially the presence of glossoptosis.

Farmer WC, Giudici SC (2000) Site of airway collapse in obstructive sleep apnea after uvulopalatopharyngoplasty. Ann Otol Rhinol Laryngol 109(6):581–584. https://doi.org/10.1177/000348940010900609CrossRefPubMed

Gamaleldin O, Bahgat A, Anwar O, Seif-Elnasr M, Eissa L, Razek A et al (2021) Role of dynamic sleep MRI in obstructive sleep apnea syndrome. Oral Radiol 37(3):376–384. https://doi.org/10.1007/s11282-020-00455-wCrossRefPubMed

Wu D, Shi H, Guo X, Li S (2013) Predictive value of lingua/pharynx ratio for retroglossal obstruction in patients with obstructive sleep apnea hypopnea syndrome. Acta Otolaryngol 133(5):504–508. https://doi.org/10.3109/00016489.2012.743172CrossRefPubMed

Friedman M, Ibrahim H, Joseph NJ (2004) Staging of obstructive sleep apnea/hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 114(3):454–459. https://doi.org/10.1097/00005537-200403000-00013CrossRefPubMed

Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S et al (1999) Clinical predictors of obstructive sleep apnea. Laryngoscope 109(12):1901–1907. https://doi.org/10.1097/00005537-199912000-00002CrossRefPubMed

Li S, Dong X, Shi H, Dong W, Qu S, Chen D et al (2002) Localization of upper airway stricture in patients with obstructive sleep apnea syndrome by CT scan. Zhonghua Er Bi Yan Hou Ke Za Zhi 37(2):133–136PubMed

Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, et al. (2016) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications: version 2.3: American Academy of Sleep Medicine

Li S, Wu D, Bao J, Shi H (2014) The nasopharyngeal tube: A simple and effective tool to indicate the need for uvulopalatopharyngoplasty. Laryngoscope 124(4):1023–1028. https://doi.org/10.1002/lary.24351CrossRefPubMed

Li S, Wu D, Shi H (2015) Reoperation on patients with obstructive sleep apnea-hypopnea syndrome after failed uvulopalatopharyngoplasty. Eur Arch Otorhinolaryngol 272(2):407–412. https://doi.org/10.1007/s00405-014-3344-4CrossRefPubMed

10.

Lee JJ, Sundar KM (2021) Evaluation and management of adults with obstructive sleep apnea syndrome. Lung 199(2):87–101. https://doi.org/10.1007/s00408-021-00426-wCrossRefPubMed

11.

Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F et al (2022) Sleep apnea syndrome (SAS) clinical practice guidelines 2020. Respir Investig 60(1):3–32. https://doi.org/10.1016/j.resinv.2021.08.010CrossRefPubMed

12.

Friedman M, Yalamanchali S, Gorelick G, Joseph NJ, Hwang MS (2015) A standardized lingual tonsil grading system: interexaminer agreement. Otolaryngol Head Neck Surg 152(4):667–672. https://doi.org/10.1177/0194599815568970CrossRefPubMed

13.

Plaza SP, Reimpell A, Silva J, Montoya D (2019) Relationship between skeletal Class II and Class III malocclusions with vertical skeletal pattern. Dental Press J Orthod 24(4):63–72. https://doi.org/10.1590/2177-6709.24.4.063-072.oarCrossRefPubMedPubMedCentral

14.

Küchler EC, Reis CLB, Carelli J, Scariot R, Nelson-Filho P, Coletta RD et al (2021) Potential interactions among single nucleotide polymorphisms in bone- and cartilage-related genes in skeletal malocclusions. Orthod Craniofac Res 24(2):277–287. https://doi.org/10.1111/ocr.12433CrossRefPubMed

15.

Fujita S, Conway W, Zorick F, Roth T (1981) Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89(6):923–934. https://doi.org/10.1177/019459988108900609CrossRefPubMed

16.

Friedman M, Vidyasagar R, Bliznikas D, Joseph N (2005) Does severity of obstructive sleep apnea/hypopnea syndrome predict uvulopalatopharyngoplasty outcome? Laryngoscope 115(12):2109–2113. https://doi.org/10.1097/01.Mlg.0000181505.11902.F7CrossRefPubMed

17.

Lai CC, Lin PW, Lin HC, Friedman M, Salapatas AM, Chen JP et al (2020) Computer-assisted quantitative analysis of drug-induced sleep endoscopy for obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 163(6):1274–1280. https://doi.org/10.1177/0194599820933206CrossRefPubMed

18.

Li S, Hei R, Wu D, Shi H (2014) Localization of glossopharyngeal obstruction using nasopharyngeal tube versus Friedman tongue position classification in obstructive sleep apnea hypopnea syndrome. Eur Arch Otorhinolaryngol 271(8):2241–2245. https://doi.org/10.1007/s00405-014-2941-6CrossRefPubMed

19.

Huo H, Li W, Tian X, Yu R, Wang J, Xu C et al (2014) Preliminary research on clinical value of localization of upper airway obstruction with nasopharyngeal airway combined with polysomnography. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 49(9):743–747PubMed

20.

Varadarajan S, Balaji TM, Raj AT, Gupta AA, Patil S, Alhazmi TH et al (2021) Genetic mutations associated with pierre robin syndrome/sequence: a systematic review. Mol Syndromol 12(2):69–86. https://doi.org/10.1159/000513217CrossRefPubMedPubMedCentral

21.

Giudice A, Barone S, Belhous K, Morice A, Soupre V, Bennardo F et al (2018) Pierre Robin sequence: a comprehensive narrative review of the literature over time. J Stomatol Oral Maxillofac Surg 119(5):419–428. https://doi.org/10.1016/j.jormas.2018.05.002CrossRefPubMed

22.

Tian X, Li WY, Huo H, Yu R, Wang J (2011) Clinical value of upper airway pressure measurement and Friedman staging system in preoperative evaluation for obstructive sleep apnea hypopnea syndrome. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 46(8):622–627PubMed

23.

Li SH, Shi HJ, Wu DH, Dong WD, Zou LG, Liu R (2007) Relationship of lingual region upper airway stricture and lingua-palate position type in obstructive sleep apnea hypopnea syndrome patients. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 42(12):910–914PubMed

24.

Liu CN, Kang KT, Yao CJ, Chen YJ, Lee PL, Weng WC et al (2022) Changes in cone-beam computed tomography pediatric airway measurements after adenotonsillectomy in patients with OSA. JAMA Otolaryngol Head Neck Surg 148(7):621–629. https://doi.org/10.1001/jamaoto.2022.0925CrossRefPubMedPubMedCentral

25.

Abramson Z, Susarla S, August M, Troulis M, Kaban L (2010) Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea. J Oral Maxillofac Surg 68(2):354–362. https://doi.org/10.1016/j.joms.2009.09.087CrossRefPubMed

Title: Analysis of the cause of retrolingual obstruction in patients with moderate–severe obstructive sleep apnea
Authors: Wanting Gao
Lei Shi
Dengxiang Xing
Jie Qin
Chenhai Zheng
Shuhua Li
Dahai Wu
Publication date: 17-11-2023
Publisher: Springer Berlin Heidelberg
Keyword: Sleep Apnea
Published in: European Archives of Oto-Rhino-Laryngology / Issue 2/2024
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08333-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Analysis of the cause of retrolingual obstruction in patients with moderate–severe obstructive sleep apnea

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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