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1 Department of Physiology, University of Arizona, Tucson, AZ, USA
2 Department of Medicine, University of Arizona, Tucson, AZ, USA
3 Department of Pediatrics, University of Arizona, Tucson, AZ, USA
4 Department of Radiology, University of Arizona, Tucson, AZ, USA
* To whom correspondence should be addressed. E-mail: fregosi{at}u.arizona.edu.
Our goal was to test the hypothesis that pharyngeal geometry and/or soft tissue dimensions correlates with the severity of sleep-disordered breathing. Magnetic resonance images (MRI) of the pharynx were obtained in 18 non-sedated children, 7-12 years of age with obstructive apnea hypopnea index (OAHI) values ranging from 1.81 to 24.2. Subjects were divided into low (N = 9) and high (N = 9) OAHI groups (2.8±0.7 and 13.5±4.9, mean ±SD, P < 0.001). The high OAHI group had significantly larger tonsils and soft palates, and the OAHI correlated significantly with the size of the tonsils (r2 = 0.42, P=0.024) and soft palate (r2 = 0.33, P=0.049). The volume of the oropharynx in the high OAHI group (3100 ± 490 mm3) was smaller than that in the low OAHI group (4300 ± 1400 mm3, P < 0.001), and was inversely correlated with the OAHI. The narrowest point in the pharyngeal airway was also smaller in the high compared to the low OAHI group (4.4 ± 1.2 vs. 6.0 ± 1.3 mm, P = 0.024), and was inversely correlated with the OAHI. Further, this point was in the retropalatal airway in all but two subjects. We also computed the cross sectional area (CSA) of the pharynx in axial slices obtained at 4 mm intervals, starting eight mm above the level of the hard palate and extending to the tip of the epiglottis. From these data we constructed an airway CSA vs. airway length curve for each group, and found a significant group difference (P = 0.001), particularly in the retropalatal region where the soft palate, adenoids and tonsils overlap. We also examined the correlation between the OAHI and the "retropalatal airspace", which was defined as the ratio of the retropalatal airway CSA to the CSA of the soft palate, and found a significant inverse correlation (r2 = 0.49, P = 0.001). The results suggest that 7-12 year old children with a large retropalatal soft tissue mass relative to the size of their retropalatal airway have significantly more apneas and hypopneas during sleep compared to children with relatively unobstructed retropalatal airways.
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