Tongue Volume Influences Lowest Oxygen Saturation but Not Apnea-Hypopnea Index in Obstructive Sleep Apnea

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2015 Aug 18

PMID 26280546

Citations 14

Authors

Sang Hyeon Ahn

Jinna Kim

Hyun Jin Min

Hyo Jin Chung

Jae Min Hong

Jeung-Gweon Lee

Chang-Hoon Kim

Hyung-Ju Cho

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of this study was to identify correlations between sleep apnea severity and tongue volume or posterior airway space measured via three-dimensional reconstruction of volumetric computerized tomography (CT) images in patients with obstructive sleep apnea (OSA) for use in predicting OSA severity and in surgical treatment. We also assessed associations between tongue volume and Mallampati score.

Methods: Snoring/OSA male patients (n = 64) who underwent polysomnography, cephalometry, and CT scans were enrolled in this retrospective study. OSA was diagnosed when the apnea-hypopnea index (AHI) was greater than 5 (mild 5-14; moderate 15-29; severe>30). The patients were also categorized into the normal-mild group (n = 22) and the moderate-severe group (n = 42). Using volumetric CT images with the three-dimensional reconstruction technique, the volume of the tongue, posterior airway space volume, and intra-mandibular space were measured. The volumes, polysomnographic parameters, and physical examination findings were compared, and independent factors that are related to OSA were analysed.

Results: No associations between tongue volume or posterior airway space and the AHI were observed. However, multivariate linear analyses showed that tongue volume had significantly negative association with lowest O2 saturation (r = 0.365, p = 0.027). High BMI was related to an increase in tongue volume. Modified Mallampati scores showed borderline significant positive correlations with absolute tongue volume (r = 0.251, p = 0.046) and standardized tongue volume (absolute tongue volume / intramandibular area; r = 0.266, p = 0.034). Between the normal-mild and moderate-severe groups, absolute tongue volumes were not different, although the standardized tongue volume in the moderate-severe group was significantly higher.

Conclusion: Absolute tongue volume showed stronger associations with lowest O2 saturation during sleep than with the severity of AHI. We also found that high BMI was a relevant factor for an increase in absolute tongue volume and modified Mallampati grading was a useful physical examination to predict tongue size.

Citing Articles

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References

Punjabi N, Polotsky V . Disorders of glucose metabolism in sleep apnea. J Appl Physiol (1985). 2005; 99(5):1998-2007. DOI: 10.1152/japplphysiol.00695.2005. View

Iida-Kondo C, Yoshino N, Kurabayashi T, Mataki S, Hasegawa M, Kurosaki N . Comparison of tongue volume/oral cavity volume ratio between obstructive sleep apnea syndrome patients and normal adults using magnetic resonance imaging. J Med Dent Sci. 2006; 53(2):119-26. View

Nashi N, Kang S, Barkdull G, Lucas J, Davidson T . Lingual fat at autopsy. Laryngoscope. 2007; 117(8):1467-73. DOI: 10.1097/MLG.0b013e318068b566. View

Tsuiki S, Isono S, Ishikawa T, Yamashiro Y, Tatsumi K, Nishino T . Anatomical balance of the upper airway and obstructive sleep apnea. Anesthesiology. 2008; 108(6):1009-15. DOI: 10.1097/ALN.0b013e318173f103. View

Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S . Clinical predictors of obstructive sleep apnea. Laryngoscope. 1999; 109(12):1901-7. DOI: 10.1097/00005537-199912000-00002. View

Peppard P, Young T, Palta M, Skatrud J . Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000; 342(19):1378-84. DOI: 10.1056/NEJM200005113421901. View

Young T, Peppard P, Gottlieb D . Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002; 165(9):1217-39. DOI: 10.1164/rccm.2109080. View

Welch K, Foster G, Ritter C, Wadden T, Arens R, Maislin G . A novel volumetric magnetic resonance imaging paradigm to study upper airway anatomy. Sleep. 2002; 25(5):532-42. View

Friedman M, Ibrahim H, Bass L . Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002; 127(1):13-21. DOI: 10.1067/mhn.2002.126477. View

10.

Yu X, Fujimoto K, Urushibata K, Matsuzawa Y, Kubo K . Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome. Chest. 2003; 124(1):212-8. DOI: 10.1378/chest.124.1.212. View

11.

Schwab R, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R . Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med. 2003; 168(5):522-30. DOI: 10.1164/rccm.200208-866OC. View

12.

Kales A, CALDWELL A, Cadieux R, Vela-Bueno A, Ruch L, Mayes S . Severe obstructive sleep apnea--II: Associated psychopathology and psychosocial consequences. J Chronic Dis. 1985; 38(5):427-34. DOI: 10.1016/0021-9681(85)90138-9. View

13.

Lowe A, Gionhaku N, Takeuchi K, Fleetham J . Three-dimensional CT reconstructions of tongue and airway in adult subjects with obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 1986; 90(5):364-74. DOI: 10.1016/0889-5406(86)90002-8. View

14.

Lowe A, Santamaria J, Fleetham J, Price C . Facial morphology and obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 1986; 90(6):484-91. DOI: 10.1016/0889-5406(86)90108-3. View

15.

Lyberg T, Krogstad O, DJUPESLAND G . Cephalometric analysis in patients with obstructive sleep apnoea syndrome. I. Skeletal morphology. J Laryngol Otol. 1989; 103(3):287-92. DOI: 10.1017/s0022215100108734. View

16.

Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S . Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J. 1999; 13(2):403-10. DOI: 10.1183/09031936.99.13240399. View

17.

. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999; 22(5):667-89. View

18.

Ogawa T, Enciso R, Memon A, Mah J, Clark G . Evaluation of 3D airway imaging of obstructive sleep apnea with cone-beam computed tomography. Stud Health Technol Inform. 2005; 111:365-8. View

19.

Young T, Finn L, Peppard P, Szklo-Coxe M, Austin D, Nieto F . Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008; 31(8):1071-8. PMC: 2542952. View

20.

Brennick M, Pack A, Ko K, Kim E, Pickup S, Maislin G . Altered upper airway and soft tissue structures in the New Zealand Obese mouse. Am J Respir Crit Care Med. 2008; 179(2):158-69. PMC: 2633061. DOI: 10.1164/rccm.200809-1435OC. View