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Upper airway imaging in sleep-disordered breathing

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Abstract

Our understanding of sleep-disordered breathing has evolved considerably over the past three decades, and clinical techniques of evaluation have progressed tremendously. Myriad imaging techniques are now available for the physician to approach the dynamic features resulting in turbulent airflow, upper airway narrowing or collapse at different levels. Controversy exists in the choice of investigations, probably because the best evaluation should be a combination of different techniques. Physical, radiographic, endoscopic and acoustic evaluations could be integrated to understand the degree and the levels of airway reduction and/or obstruction in a given patient. This review focuses on cost-effective and easily implemented techniques in daily practice, allowing quality assessment of the dynamic anatomy of sleep-disordered breathing: cephalometry, (sleep-)endoscopy and acoustic reflectometry of the upper airway.

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References

  1. Kotecha B (2011) The nose, snoring and obstructive sleep apnoea. Rhinology 49:259–263

    CAS  PubMed  Google Scholar 

  2. Poirrier AL, Eloy P, Rombaux P (2013) Nose and sleep breathing disorders. In: Nasal physiology and pathophysiology of nasal disorders. Springer Berlin, Heidelberg GmbH & Co. K, 604–624

  3. Schwab RJ (1998) Upper airway imaging. Clin Chest Med 19:33–54

    Article  CAS  PubMed  Google Scholar 

  4. Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T (1997) Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol 82:1319–1326

    CAS  PubMed  Google Scholar 

  5. Isono S (2012) Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology 17:32–42

    Article  PubMed  Google Scholar 

  6. Chen NH, Li KK, Li SY, Wong CR, Chuang ML, Hwang CC, Wu YK (2002) Airway assessment by volumetric computed tomography in snorers and subjects with obstructive sleep apnea in a Far-East Asian population (Chinese). Laryngoscope 112:721–726

    Article  PubMed  Google Scholar 

  7. Smith TH, Baska RE, Francisco CB, McCray GM, Kunz S (1978) Sleep apnea syndrome: diagnosis of upper airway obstruction by fluoroscopy. J Pediatr 93:891–892

    Article  CAS  PubMed  Google Scholar 

  8. Suratt PM, Dee P, Atkinson RL, Armstrong P, Wilhoit SC (1983) Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis 127:487–492

    CAS  PubMed  Google Scholar 

  9. Pepin JL, Ferretti G, Veale D, Romand P, Coulomb M, Brambilla C, Levy PA (1992) Somnofluoroscopy, computed tomography, and cephalometry in the assessment of the airway in obstructive sleep apnoea. Thorax 47:150–156

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Schwartz BA, Escande JP (1967) Etude cinématographique de la respiration hypnique Pickwickienne. Revue Neurol 116:677–678

    CAS  Google Scholar 

  11. Kurtz D, Krieger J (1978) Les arrêts respiratoires au cours du sommeil. Faits et hypothèses. Revue Neurol 134:11–22

    CAS  Google Scholar 

  12. Verbraecken JA, De Backer WA (2009) Upper airway mechanics. Respir Int Rev Thoracic Dis 78:121–133

    Google Scholar 

  13. Susarla SM, Thomas RJ, Abramson ZR, Kaban LB (2010) Biomechanics of the upper airway: changing concepts in the pathogenesis of obstructive sleep apnea. Int J Oral Maxillofac Surg 39:1149–1159

    Article  CAS  PubMed  Google Scholar 

  14. De Backer JW, Vos WG, Verhulst SL, De Backer W (2008) Novel imaging techniques using computer methods for the evaluation of the upper airway in patients with sleep-disordered breathing: a comprehensive review. Sleep Med Rev 12:437–447

    Article  PubMed  Google Scholar 

  15. Riley R, Guilleminault C, Herran J, Powell N (1983) Cephalometric analyses and flow-volume loops in obstructive sleep apnea patients. Sleep 6:303–311

    CAS  PubMed  Google Scholar 

  16. Jamieson A, Guilleminault C, Partinen M, Quera-Salva MA (1986) Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 9:469–477

    CAS  PubMed  Google Scholar 

  17. Lowe AA, Santamaria JD, Fleetham JA, Price C (1986) Facial morphology and obstructive sleep apnea. Am J Orthod Dentofac Orthop 90:484–491

    Article  CAS  Google Scholar 

  18. Bacon WH, Krieger J, Turlot JC, Stierle JL (1988) Craniofacial characteristics in patients with obstructive sleep apneas syndrome. Cleft Palate J 25:374–378

    CAS  PubMed  Google Scholar 

  19. de Berry-Borowiecki B, Kukwa A, Blanks RH (1988) Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope 98:226–234

    Google Scholar 

  20. Andersson L, Brattstrom V (1991) Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome. Int J Oral Maxillofac Surg 20:159–162

    Article  CAS  PubMed  Google Scholar 

  21. Lowe AA, Fleetham JA, Adachi S, Ryan CF (1995) Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofac Orthop 107:589–595

    Article  CAS  Google Scholar 

  22. Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr (1996) Craniofacial structure and obstructive sleep apnea syndrome—a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofac Orthop 109:163–172

    Article  CAS  Google Scholar 

  23. Lowe AA, Ono T, Ferguson KA, Pae EK, Ryan CF, Fleetham JA (1996) Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. Am J Orthod Dentofac Orthop 110:653–664

    Article  CAS  Google Scholar 

  24. Nelson S, Hans M (1997) Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest 111:154–162

    Article  CAS  PubMed  Google Scholar 

  25. Verin E, Tardif C, Buffet X, Marie JP, Lacoume Y, Andrieu-Guitrancourt J, Pasquis P (2002) Comparison between anatomy and resistance of upper airway in normal subjects, snorers and OSAS patients. Respir Physiol 129:335–343

    Article  CAS  PubMed  Google Scholar 

  26. Tangugsorn V, Krogstad O, Espeland L, Lyberg T (2000) Obstructive sleep apnoea: multiple comparisons of cephalometric variables of obese and non-obese patients. J Craniomaxillofac Surg 28:204–212

    Article  CAS  PubMed  Google Scholar 

  27. Will MJ, Ester MS, Ramirez SG, Tiner BD, McAnear JT, Epstein L (1995) Comparison of cephalometric analysis with ethnicity in obstructive sleep apnea syndrome. Sleep 18:873–875

    CAS  PubMed  Google Scholar 

  28. Redline S, Tishler PV, Hans MG, Tosteson TD, Strohl KP, Spry K (1997) Racial differences in sleep-disordered breathing in African-Americans and Caucasians. Am J Respir Crit Care Med 155:186–192

    Article  CAS  PubMed  Google Scholar 

  29. Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C (2000) Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope 110:1689–1693

    Article  CAS  PubMed  Google Scholar 

  30. Wong ML, Sandham A, Ang PK, Wong DC, Tan WC, Huggare J (2005) Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea: an inter-ethnic comparison. Eur J Orthod 27:91–97

    Article  PubMed  Google Scholar 

  31. Coltman R, Taylor DR, Whyte K, Harkness M (2000) Craniofacial form and obstructive sleep apnea in Polynesian and Caucasian men. Sleep 23:943–950

    CAS  PubMed  Google Scholar 

  32. Finkelstein Y, Wexler D, Horowitz E, Berger G, Nachmani A, Shapiro-Feinberg M, Ophir D (2001) Frontal and lateral cephalometry in patients with sleep-disordered breathing. Laryngoscope 111:634–641

    Article  CAS  PubMed  Google Scholar 

  33. Poirrier AL, Pire S, Raskin S, Limme M, Poirrier R (2012) Contribution of postero-anterior cephalometry in obstructive sleep apnea. Laryngoscope 122:2350–2354

    Article  PubMed  Google Scholar 

  34. Guilleminault C, Stoohs R (1992) From apnea of infancy to obstructive sleep apnea syndrome in the young child. Chest 102:1065–1071

    Article  CAS  PubMed  Google Scholar 

  35. Linder-Aronson S (1979) Naso-respiratory function and craniofacial growth. In: McNamara James A (ed.) Naso-respiratory function and craniofacial growth, Monograph No. 9, Craniofacial Growth Series. University of Michigan, Ann Arbor, pp 121–147

  36. Pepin JL, Veale D, Ferretti GR, Mayer P, Levy PA (1999) Obstructive sleep apnea syndrome: hooked appearance of the soft palate in awake patients—cephalometric and CT findings. Radiology 210:163–170

    Article  CAS  PubMed  Google Scholar 

  37. Ngan DC, Kharbanda OP, Geenty JP, Darendeliler MA (2003) Comparison of radiation levels from computed tomography and conventional dental radiographs. Aus Orthod J 19:67–75

    Google Scholar 

  38. Alcaraz M, Garcia-Vera MC, Bravo LA, Martinez-Beneyto Y, Armero D, Morant JJ, Canteras M (2009) Collimator with filtration compensator: clinical adaptation to meet European Union recommendation 4F on radiological protection for dental radiography. Dento Maxillo Fac Radiol 38:413–420

    Article  CAS  Google Scholar 

  39. Buch B, Fensham R (2003) Orthodontic radiographic procedures-how safe are they? J S Afr Dental Assoc 58:6–10

    CAS  Google Scholar 

  40. Guijarro-Martinez R, Swennen GR (2011) Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature. Int J Oral Maxillofac Surg 40:1227–1237

    Article  CAS  PubMed  Google Scholar 

  41. Randerath WJ, Verbraecken J, Andreas S et al (2011) Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J 37:1000–1028

    Article  CAS  PubMed  Google Scholar 

  42. Van de Heyning PH, Badr MS, Baskin JZ et al (2012) Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope 122:1626–1633

    Article  PubMed  Google Scholar 

  43. Katsantonis GP, Maas CS, Walsh JK (1989) The predictive efficacy of the Muller maneuver in uvulopalatopharyngoplasty. Laryngoscope 99:677–680

    Article  CAS  PubMed  Google Scholar 

  44. Skatvedt O (1993) Localization of site of obstruction in snorers and patients with obstructive sleep apnea syndrome: a comparison of fiberoptic nasopharyngoscopy and pressure measurements. Acta Otolaryngol 113:206–209

    Article  CAS  PubMed  Google Scholar 

  45. Petri N, Suadicani P, Wildschiodtz G, Bjorn-Jorgensen J (1994) Predictive value of Muller maneuver, cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty. Evaluation of predictive factors using discriminant analysis in 30 sleep apnea patients. Acta Otolaryngol 114:565–571

    Article  CAS  PubMed  Google Scholar 

  46. Doghramji K, Jabourian ZH, Pilla M, Farole A, Lindholm RN (1995) Predictors of outcome for uvulopalatopharyngoplasty. Laryngoscope 105:311–314

    Article  CAS  PubMed  Google Scholar 

  47. Remmers JE, Launois S, Feroah T, Whitelaw WA (1990) Mechanics of the pharynx in patients with obstructive sleep apnea. Prog Clin Biol Res 345:261–268 discussion 269–71

    CAS  PubMed  Google Scholar 

  48. Launois SH, Feroah TR, Campbell WN, Issa FG, Morrison D, Whitelaw WA, Isono S, Remmers JE (1993) Site of pharyngeal narrowing predicts outcome of surgery for obstructive sleep apnea. Am Rev Respir Dis 147:182–189

    Article  CAS  PubMed  Google Scholar 

  49. Croft CB, Thomson HG, Samuels MP, Southall DP (1990) Endoscopic evaluation and treatment of sleep-associated upper airway obstruction in infants and young children. Clin Otolaryngol Allied Sci 15:209–216

    Article  CAS  PubMed  Google Scholar 

  50. Croft CB, Pringle M (1991) Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 16:504–509

    Article  CAS  PubMed  Google Scholar 

  51. Sadaoka T, Kakitsuba N, Fujiwara Y, Kanai R, Takahashi H (1996) The value of sleep nasendoscopy in the evaluation of patients with suspected sleep-related breathing disorders. Clin Otolaryngol Allied Sci 21:485–489

    Article  CAS  PubMed  Google Scholar 

  52. Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268:1233–1236

    Article  PubMed  Google Scholar 

  53. Ravesloot MJ, de Vries N (2011) One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope 121:2710–2716

    Article  PubMed  Google Scholar 

  54. Bachar G, Nageris B, Feinmesser R, Hadar T, Yaniv E, Shpitzer T, Eidelman L (2012) Novel grading system for quantifying upper-airway obstruction on sleep endoscopy. Lung 190:313–318

    Article  PubMed  Google Scholar 

  55. Kezirian EJ (2011) Nonresponders to pharyngeal surgery for obstructive sleep apnea: insights from drug-induced sleep endoscopy. Laryngoscope 121:1320–1326

    Article  PubMed Central  PubMed  Google Scholar 

  56. van Maanen JP, Ravesloot MJ, Witte BI, Grijseels M, de Vries N (2012) Exploration of the relationship between sleep position and isolated tongue base or multilevel surgery in obstructive sleep apnea. Eur Arch Otorhinolaryngol 269:2129–2136

    Article  PubMed Central  PubMed  Google Scholar 

  57. Kotecha BT, Hannan SA, Khalil HM, Georgalas C, Bailey P (2007) Sleep nasendoscopy: a 10-year retrospective audit study. Eur Arch Otorhinolaryngol 264:1361–1367

    Article  PubMed  Google Scholar 

  58. Armstrong J, Leigh M, Walton I, Zvyagin A, Alexandrov S, Schwer S, Sampson D, Hillman D, Eastwood P (2003) In vivo size and shape measurement of the human upper airway using endoscopic longrange optical coherence tomography. Opt Express 11:1817–1826

    Article  PubMed  Google Scholar 

  59. Kotecha B, Kumar G, Sands R, Walden A, Gowers B (2013) Evaluation of upper airway obstruction in snoring patients using digital video stroboscopy. Eur Arch Otorhinolaryngol 270:2141–2147

    Article  PubMed  Google Scholar 

  60. Fredberg JJ, Wohl ME, Glass GM, Dorkin HL (1980) Airway area by acoustic reflections measured at the mouth. J Appl Physiol Respir Environ Exerc Physiol 48:749–758

    CAS  PubMed  Google Scholar 

  61. Bradley TD, Brown IG, Grossman RF, Zamel N, Martinez D, Phillipson EA, Hoffstein V (1986) Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea. N Engl J Med 315:1327–1331

    Article  CAS  PubMed  Google Scholar 

  62. Hoffstein V, Wright S, Zamel N, Bradley TD (1991) Pharyngeal function and snoring characteristics in apneic and nonapneic snorers. Am Rev Respir Dis 143:1294–1299

    Article  CAS  PubMed  Google Scholar 

  63. Kamal I (2004) Test–retest validity of acoustic pharyngometry measurements. Otolaryngol Head Neck Surg 130:223–228

    Article  PubMed  Google Scholar 

  64. Kamal I (2004) Acoustic pharyngometry patterns of snoring and obstructive sleep apnea patients. Otolaryngol Head Neck Surg 130:58–66

    Article  PubMed  Google Scholar 

  65. Dubois AB, Brody AW, Lewis DH, Burgess BF Jr (1956) Oscillation mechanics of lungs and chest in man. J Appl Physiol 8:587–594

    CAS  PubMed  Google Scholar 

  66. Randerath WJ, Parys K, Feldmeyer F, Sanner B, Ruhle KH (1999) Self-adjusting nasal continuous positive airway pressure therapy based on measurement of impedance: a comparison of two different maximum pressure levels. Chest 116:991–999

    Article  CAS  PubMed  Google Scholar 

  67. Farre R, Rigau J, Montserrat JM, Ballester E, Navajas D (2001) Evaluation of a simplified oscillation technique for assessing airway obstruction in sleep apnoea. Eur Respir J 17:456–461

    Article  CAS  PubMed  Google Scholar 

  68. Farre R, Mancini M, Rotger M, Ferrer M, Roca J, Navajas D (2001) Oscillatory resistance measured during noninvasive proportional assist ventilation. Am J Respir Crit Care Med 164:790–794

    Article  CAS  PubMed  Google Scholar 

  69. Badia JR, Farre R, Montserrat JM, Ballester E, Hernandez L, Rotger M, Rodriguez-Roisin R, Navajas D (1998) Forced oscillation technique for the evaluation of severe sleep apnoea/hypopnoea syndrome: a pilot study. Eur Respir J 11:1128–1134

    Article  CAS  PubMed  Google Scholar 

  70. Vanderveken OM, Oostveen E, Boudewyns AN, Verbraecken JA, Van de Heyning PH, De Backer WA (2005) Quantification of pharyngeal patency in patients with sleep-disordered breathing. ORL J Otorhinolaryngol Relat Spec 67:168–179

    Article  PubMed  Google Scholar 

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Poirrier, AL., Fanielle, J., Bruwier, A. et al. Upper airway imaging in sleep-disordered breathing. Acta Neurol Belg 114, 87–93 (2014). https://doi.org/10.1007/s13760-013-0278-3

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