Upper airway imaging in obstructive sleep apnea in adults
- Richard J Schwab, MD
Richard J Schwab, MD
- Professor of Medicine
- University of Pennsylvania Medical Center
Upper airway imaging is currently not part of the routine diagnostic evaluation for obstructive sleep apnea (OSA) because it can neither confirm nor exclude the disorder. Despite this, it has several roles:
●Upper airway imaging provides information about soft tissue and craniofacial anatomy, which has provided important insights into the pathogenesis of OSA [1-7]. Upper airway imaging can also identify anatomic risk factors for sleep apnea such as enlargement of upper airway soft tissue structures , tongue fat , and reduction in the size of craniofacial structures .
●Upper airway imaging can be clinically useful in patients with OSA who are imaged to identify potential sites of upper airway obstruction prior to surgical intervention, although validation of this approach has not been addressed with well-performed clinical trials.
●Upper airway imaging may discover pathologic masses or growths that reduce upper airway size, leading to OSA.
The methods of upper airway imaging and the clinical settings in which upper airway imaging may be helpful are reviewed here. The diagnostic evaluation of OSA is described separately. (See "Clinical presentation and diagnosis of obstructive sleep apnea in adults".)
- Schwab RJ, Gupta KB, Gefter WB, et al. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 1995; 152:1673.
- Mortimore IL, Marshall I, Wraith PK, et al. Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 1998; 157:280.
- Ciscar MA, Juan G, Martínez V, et al. Magnetic resonance imaging of the pharynx in OSA patients and healthy subjects. Eur Respir J 2001; 17:79.
- Arens R, McDonough JM, Costarino AT, et al. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2001; 164:698.
- Malhotra A, Huang Y, Fogel RB, et al. The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med 2002; 166:1388.
- Welch KC, Foster GD, Ritter CT, et al. A novel volumetric magnetic resonance imaging paradigm to study upper airway anatomy. Sleep 2002; 25:532.
- Schwab RJ, Pasirstein M, Pierson R, et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003; 168:522.
- Kim AM, Keenan BT, Jackson N, et al. Tongue fat and its relationship to obstructive sleep apnea. Sleep 2014; 37:1639.
- Chi L, Comyn FL, Keenan BT, et al. Heritability of craniofacial structures in normal subjects and patients with sleep apnea. Sleep 2014; 37:1689.
- Schwab RJ, Pasirstein M, Kaplan L, et al. Family aggregation of upper airway soft tissue structures in normal subjects and patients with sleep apnea. Am J Respir Crit Care Med 2006; 173:453.
- Trudo FJ, Gefter WB, Welch KC, et al. State-related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects. Am J Respir Crit Care Med 1998; 158:1259.
- Morrell MJ, Arabi Y, Zahn B, Badr MS. Progressive retropalatal narrowing preceding obstructive apnea. Am J Respir Crit Care Med 1998; 158:1974.
- Chen H, Aarab G, de Ruiter MH, et al. Three-dimensional imaging of the upper airway anatomy in obstructive sleep apnea: a systematic review. Sleep Med 2016; 21:19.
- Watanabe T, Isono S, Tanaka A, et al. Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing. Am J Respir Crit Care Med 2002; 165:260.
- Lee RW, Vasudavan S, Hui DS, et al. Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep 2010; 33:1075.
- Schwab RJ, Pack AI, Gupta KB, et al. Upper airway and soft tissue structural changes induced by CPAP in normal subjects. Am J Respir Crit Care Med 1996; 154:1106.
- Schwab RJ, Kim C, Siegel L, et al. Examining the mechanism of action of a new device using oral pressure therapy for the treatment of obstructive sleep apnea. Sleep 2014; 37:1237.
- Chan AS, Sutherland K, Schwab RJ, et al. The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 2010; 65:726.
- Chiffer RC, Schwab RJ, Keenan BT, et al. Volumetric MRI analysis pre- and post-Transoral robotic surgery for obstructive sleep apnea. Laryngoscope 2015; 125:1988.
- Okuno K, Sasao Y, Nohara K, et al. Endoscopy evaluation to predict oral appliance outcomes in obstructive sleep apnoea. Eur Respir J 2016; 47:1410.
- Ritter CT, Trudo FJ, Goldberg AN, et al. Quantitative evaluation of the upper airway during nasopharyngoscopy with the Müller maneuver. Laryngoscope 1999; 109:954.
- Cavaliere M, Russo F, Iemma M. Awake versus drug-induced sleep endoscopy: evaluation of airway obstruction in obstructive sleep apnea/hypopnoea syndrome. Laryngoscope 2013; 123:2315.
- Soares D, Folbe AJ, Yoo G, et al. Drug-induced sleep endoscopy vs awake Müller's maneuver in the diagnosis of severe upper airway obstruction. Otolaryngol Head Neck Surg 2013; 148:151.
- Kezirian EJ, White DP, Malhotra A, et al. Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 2010; 136:393.
- Vroegop AV, Vanderveken OM, Wouters K, et al. Observer variation in drug-induced sleep endoscopy: experienced versus nonexperienced ear, nose, and throat surgeons. Sleep 2013; 36:947.
- Borek RC, Thaler ER, Kim C, et al. Quantitative airway analysis during drug-induced sleep endoscopy for evaluation of sleep apnea. Laryngoscope 2012; 122:2592.
- Armstrong JJ, Leigh MS, Sampson DD, et al. Quantitative upper airway imaging with anatomic optical coherence tomography. Am J Respir Crit Care Med 2006; 173:226.
- Shepard JW Jr, Thawley SE. Evaluation of the upper airway by computerized tomography in patients undergoing uvulopalatopharyngoplasty for obstructive sleep apnea. Am Rev Respir Dis 1989; 140:711.
- Schwab RJ. Imaging for the snoring and sleep apnea patient. Dent Clin North Am 2001; 45:759.
- UPPER AIRWAY ANATOMY
- IMAGING IN PATHOGENESIS AND MANAGEMENT
- IMAGING MODALITIES
- Magnetic resonance imaging
- Nasopharyngoscopy and drug-induced sleep endoscopy
- Computed tomography
- Acoustic reflection
- Optical coherence tomography
- Uvulopalatopharyngoplasty (UPPP)
- Maxillomandibular advancement
- Oral appliances
- SUMMARY AND RECOMMENDATIONS