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1 Department of Anesthesiology, Chiba University School of Medicine, Chiba, 260 Japan; and 2 Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 4N1
Received 15 July 1996; accepted in final form 4 December 1996.
Isono, Shiroh, John E Remmers, Atsuko Tanaka, Yasuhide Sho,
Jiro Sato, and Takashi Nishino. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects.
J. Appl. Physiol. 82(4):
1319-1326, 1997.
Anatomic abnormalities of the pharynx are
thought to play a role in the pathogenesis of obstructive sleep apnea
(OSA), but their contribution has never been conclusively proven. The
present study tested this anatomic hypothesis by comparing the
mechanics of the paralyzed pharynx in OSA patients and in normal
subjects. According to evaluation of sleep-disordered breathing (SDB)
by nocturnal oximetry, subjects were divided into three groups: normal
group (n = 17), SDB-1
(n = 18), and SDB-2
(n = 22). The static pressure-area
relationship of the passive pharynx was quantified under general
anesthesia with complete paralysis. Age and body mass index were
matched among the three groups. The site of the primary closure was the
velopharynx in 49 subjects and the oropharynx in only 8 subjects.
Distribution of the location of the primary closure did not differ
among the groups. Closing pressure
(PC) of the velopharynx for
SDB-1 and SDB-2 groups (0.90 ± 1.34 and 2.78 ± 2.78 cmH2O, respectively) was
significantly higher than that for the normal group (
3.77 ± 3.44 cmH2O;
P < 0.01). Maximal velopharyngeal
area for the normal group (2.10 ± 0.85 cm2) was significantly greater
than for SDB-1 and SDB-2 groups (1.15 ± 0.46 and 1.06 ± 0.75 cm2, respectively). The
shape of the pressure-area curve for the velopharynx differed between
normal subjects and patients with SDB, being steeper in slope near
PC in patients with SDB.
Multivariate analysis of mechanical parameters and oxygen desaturation
index (ODI) revealed that velopharyngeal
PC was the only variable highly correlated with ODI. Velopharyngeal
PC was associated with
oropharyngeal PC, suggesting
mechanical interdependence of these segments. We conclude that the
passive pharynx is more narrow and collapsible in sleep-apneic patients
than in matched controls and that velopharyngeal PC is the principal correlate of
the frequency of nocturnal desaturations.
static pressure-area relationship; closing pressure; oxygen desaturation; pharyngeal compliance
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