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J Appl Physiol 82: 1319-1326, 1997;
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Journal of Applied Physiology
Vol. 82, No. 4, pp. 1319-1326, April 1997
CONTROL OF BREATHING, CIRCULATION, AND TEMPERATURE

Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects

Shiroh Isono1, John E. Remmers2, Atsuko Tanaka1, Yasuhide Sho1, Jiro Sato1, and Takashi Nishino1

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

0161-7567/97 $5.00 Copyright © 1997 the American Physiological Society




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F. J. TRUDO, W. B. GEFTER, K. C. WELCH, K. B. GUPTA, G. MAISLIN, and R. J. SCHWAB
State-related Changes in Upper Airway Caliber and Surrounding Soft-Tissue Structures in Normal Subjects
Am. J. Respir. Crit. Care Med., October 1, 1998; 158(4): 1259 - 1270.
[Abstract] [Full Text] [PDF]

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 J. Physiol.Home page
J. A Rowley, B. R Zahn, M. A Babcock, and M S. Badr
The effect of rapid eye movement (REM) sleep on upper airway mechanics in normal human subjects
J. Physiol., August 1, 1998; 510(3): 963 - 976.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
R. FARRE, R. PESLIN, J. M. MONTSERRAT, M. ROTGER, and D. NAVAJAS
Flow-dependent Positive Airway Pressure to Maintain Airway Patency in Sleep Apnea-Hypopnea Syndrome
Am. J. Respir. Crit. Care Med., June 1, 1998; 157(6): 1855 - 1863.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
J. E. REMMERS and S. LAHIRI
Regulating the Ventilatory Pump . A Splendid Control System Prone to Fail During Sleep
Am. J. Respir. Crit. Care Med., April 1, 1998; 157(4): S95 - S100.
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 Am. J. Respir. Crit. Care Med.Home page
A. R. SCHWARTZ, C. P. O'DONNELL, J. BARON, N. SCHUBERT, D. ALAM, S. D. SAMADI, and P. L. SMITH
The Hypotonic Upper Airway in Obstructive Sleep Apnea . Role of Structures and Neuromuscular Activity
Am. J. Respir. Crit. Care Med., April 1, 1998; 157(4): 1051 - 1057.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
S. ISONO, A. SHIMADA, M. UTSUGI, A. KONNO, and T. NISHINO
Comparison of Static Mechanical Properties of the Passive Pharynx between Normal Children and Children with Sleep-disordered Breathing
Am. J. Respir. Crit. Care Med., April 1, 1998; 157(4): 1204 - 1212.
[Abstract] [Full Text] [PDF]

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 J. Appl. Physiol.Home page
M. J. Morrell and M. S. Badr
Effects of NREM sleep on dynamic within-breath changes in upper airway patency in humans
J Appl Physiol, January 1, 1998; 84(1): 190 - 199.
[Abstract] [Full Text] [PDF]


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