Airflow Shape Is Associated With the Pharyngeal Structure Causing OSA

• Published in: Chest Vol. 152; no. 3; p. 537
• Main Authors: Genta, Pedro R, Sands, Scott A, Butler, James P, Loring, Stephen H, Katz, Eliot S, Demko, B Gail, Kezirian, Eric J, White, David P, Wellman, Andrew
• Format: Journal Article
• Language: English
• Published: United States 01.09.2017
• Subjects: Adult; Airway Resistance - physiology; Bronchoscopy; Epiglottis - pathology; Epiglottis - physiopathology; Female; Humans; Inhalation - physiology; Inspiratory Capacity; Male; Maximal Respiratory Pressures; Middle Aged; Palate - pathology; Palate - physiopathology; Pharynx - pathology; Pharynx - physiopathology; Sleep Apnea, Obstructive - etiology; Sleep Apnea, Obstructive - pathology; Sleep Apnea, Obstructive - physiopathology; Tongue - pathology; Tongue - physiopathology; site of pharyngeal collapse; OSA; flow shape
• ISSN: 1931-3543
• DOI: 10.1016/j.chest.2017.06.017

OSA results from the collapse of different pharyngeal structures (soft palate, tongue, lateral walls, and epiglottis). The structure involved in collapse has been shown to impact non-CPAP OSA treatment. Different inspiratory airflow shapes are also observed among patients with OSA. We hypothesized that inspiratory flow shape reflects the underlying pharyngeal structure involved in airway collapse. Subjects with OSA were studied with a pediatric endoscope and simultaneous nasal flow and pharyngeal pressure recordings during natural sleep. The mechanism causing collapse was classified as tongue-related, isolated palatal, lateral walls, or epiglottis. Flow shape was classified according to the degree of negative effort dependence (NED), defined as the percent reduction in inspiratory flow from peak to plateau. Thirty-one subjects with OSA (mean apnea-hypopnea index score ± SD, 54 ± 27 events/h) who were 50 ± 9 years of age were studied. NED was associated with the structure causing collapse (P < .001). Tongue-related obstruction (n = 13) was associated with a small amount of NED (median, 19; interquartile range [IQR], 14%-25%). Moderate NED was found among subjects with isolated palatal collapse (median, 45; IQR, 39%-52%; n = 8) and lateral wall collapse (median, 50; IQR, 44%-64%; n = 8). The epiglottis was associated with severe NED (median, 89; IQR, 78%-91%) and abrupt discontinuities in inspiratory flow (n = 9). Inspiratory flow shape is influenced by the pharyngeal structure causing collapse. Flow shape analysis may be used as a noninvasive tool to help determine the pharyngeal structure causing collapse.