Analysis of upper airway obstruction by sleep videofluoroscopy in obstructive sleep apnea

A Large Population-Based Study

Authors

  • Chul Hee Lee MD, PhD,

    1. Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
    Search for more papers by this author
    • Chul Hee Lee, MD, PhD, and Sung-Lyong Hong, MD, contributed equally to this work.

  • Sung-Lyong Hong MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Pusan
    Search for more papers by this author
    • Chul Hee Lee, MD, PhD, and Sung-Lyong Hong, MD, contributed equally to this work.

  • Chae-Seo Rhee MD, PhD,

    1. Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
    Search for more papers by this author
  • Sang-Wook Kim MD,

    1. Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
    Search for more papers by this author
  • Jeong-Whun Kim MD, PhD

    Corresponding author
    1. Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
    • Assistant Professor, Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Goomi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 464-707, South Korea
    Search for more papers by this author

  • This study was partly supported by an SNUBH grant. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To analyze the pattern of the upper airway obstruction in a large cohort of obstructive sleep apnea (OSA) patients using sleep videofluoroscopy (SVF).

Study Design:

Retrospective analysis.

Methods:

This study included 922 OSA patients who underwent both polysomnography and SVF. Their mean age, apnea-hypopnea index, and body mass index were 46.8 years, 34.2 per hour, and 26.2 kg/m2, respectively. Sleep was induced by intravenous injection of midazolam, and the obstruction pattern was determined on SVF when oxygen saturation dropped by more than 4% in pulse oxymetry.

Results:

The anatomic structure and airway level, which were most commonly involved in obstruction, were the soft palate (77.9%) and the oropharynx (88.1%), respectively. The soft palate alone was the most common obstructed structure in mild OSA (43.2%), and the combination of the soft palate and the tongue base was more frequent in severe OSA (45.2%). The tongue base or the hypopharynx was progressively more involved in moderate/severe OSA cases (P < .001, respectively), and a multiplicity of obstruction pattern also increased according to OSA severity (P < .001). However, 32.4% of the patients with mild OSA also had multiple obstructive anatomic structures.

Conclusions:

Even if multiplicity of obstruction pattern was most commonly associated with severe OSA, almost one third of mild OSA patients also showed multiple anatomic structures and levels of obstruction. Therefore, a precise evaluation for multiplicity of obstruction patterns should precede the decision of a treatment plan, regardless of disease severity.

Ancillary