SEARCH

SEARCH BY CITATION

Keywords:

  • Obstructive sleep apnea;
  • fluoroscopy;
  • polysomnography;
  • airway obstruction;
  • tongue;
  • soft palate;
  • oropharynx;
  • velopharynx;
  • hypopharynx;
  • Level of Evidence: 2b

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.