Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | https://repositorio.unifesp.br/handle/11600/54990 http://dx.doi.org/10.1093/sleep/zsx005 |
Resumo: | Objectives: In some patients, obstructive sleep apnea (OSA) can be resolved with improvement in pharyngeal patency by sleeping lateral rather than supine, possibly as gravitational effects on the tongue are relieved. Here we tested the hypothesis that the improvement in pharyngeal patency depends on the anatomical structure causing collapse, with patients with tongue-related obstruction and epiglottic collapse exhibiting preferential improvements. Methods: Twenty-four OSA patients underwent upper airway endoscopy during natural sleep to determine the pharyngeal structure associated with obstruction, with simultaneous recordings of airflow and pharyngeal pressure. Patients were grouped into three categories based on supine endoscopy: Tongue-related obstruction (posteriorly located tongue, N = 10), non-tongue related obstruction (collapse due to the palate or lateral walls, N = 8), and epiglottic collapse (N = 6). Improvement in pharyngeal obstruction was quantified using the change in peak inspiratory airflow and minute ventilation lateral versus supine. Results: Contrary to our hypothesis, patients with tongue-related obstruction showed no improvement in airflow, and the tongue remained posteriorly located while lateral. Patients without tongue involvement showed modest improvement in airflow (peak flow increased 0.07 L/s and ventilation increased 1.5 L/min). Epiglottic collapse was virtually abolished with lateral positioning and ventilation increased by 45% compared to supine position. Conclusions: Improvement in pharyngeal patency with sleeping position is structure specific, with profound improvements seen in patients with epiglottic collapse, modest effects in those without tongue involvement and-unexpectedly-no effect in those with tongue-related obstruction. Our data refute the notion that the tongue falls back into the airway during sleep via gravitational influences. |
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Marques, MelaniaGenta, Pedro R.Sands, Scott A.Azarbazin, Alide Melo, Camila [UNIFESP]Taranto-Montemurro, LuigiWhite, David P.Wellman, Andrew2020-07-17T14:02:45Z2020-07-17T14:02:45Z2017Sleep. Cary, v. 40, n. 3, p. -, 2017.1550-9109https://repositorio.unifesp.br/handle/11600/54990http://dx.doi.org/10.1093/sleep/zsx00510.1093/sleep/zsx005WOS:000398921100022Objectives: In some patients, obstructive sleep apnea (OSA) can be resolved with improvement in pharyngeal patency by sleeping lateral rather than supine, possibly as gravitational effects on the tongue are relieved. Here we tested the hypothesis that the improvement in pharyngeal patency depends on the anatomical structure causing collapse, with patients with tongue-related obstruction and epiglottic collapse exhibiting preferential improvements. Methods: Twenty-four OSA patients underwent upper airway endoscopy during natural sleep to determine the pharyngeal structure associated with obstruction, with simultaneous recordings of airflow and pharyngeal pressure. Patients were grouped into three categories based on supine endoscopy: Tongue-related obstruction (posteriorly located tongue, N = 10), non-tongue related obstruction (collapse due to the palate or lateral walls, N = 8), and epiglottic collapse (N = 6). Improvement in pharyngeal obstruction was quantified using the change in peak inspiratory airflow and minute ventilation lateral versus supine. Results: Contrary to our hypothesis, patients with tongue-related obstruction showed no improvement in airflow, and the tongue remained posteriorly located while lateral. Patients without tongue involvement showed modest improvement in airflow (peak flow increased 0.07 L/s and ventilation increased 1.5 L/min). Epiglottic collapse was virtually abolished with lateral positioning and ventilation increased by 45% compared to supine position. Conclusions: Improvement in pharyngeal patency with sleeping position is structure specific, with profound improvements seen in patients with epiglottic collapse, modest effects in those without tongue involvement and-unexpectedly-no effect in those with tongue-related obstruction. Our data refute the notion that the tongue falls back into the airway during sleep via gravitational influences.Apnicure Inc.Philips RespironicsDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Med, Boston, MA USAHarvard Med Sch, Brigham & Womens Hosp, Dept Neurol, Boston, MA USAUniv Sao Paulo, Sch Med, Hosp Clin, Pulm Div,Heart Inst InCor, Sao Paulo, BrazilAlfred, Dept Allergy Immunol & Resp Med, Melbourne, AustraliaAlfred, Cent Clin Sch, Melbourne, AustraliaMonash Univ, Melbourne, Vic, AustraliaUniv Fed Sao Paulo, UNIFESP, Dept Psychobiol, Sao Paulo, BrazilUniv Fed Sao Paulo, UNIFESP, Dept Psychobiol, Sao Paulo, BrazilWeb of Science-engOxford Univ Press IncSleepSupine positionairway obstructionepiglottissleep apneaEffect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapseinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleCary403info:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP11600/549902021-10-05 21:33:38.701metadata only accessoai:repositorio.unifesp.br:11600/54990Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-05-25T12:12:06.770812Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse |
title |
Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse |
spellingShingle |
Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse Marques, Melania Supine position airway obstruction epiglottis sleep apnea |
title_short |
Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse |
title_full |
Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse |
title_fullStr |
Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse |
title_full_unstemmed |
Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse |
title_sort |
Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse |
author |
Marques, Melania |
author_facet |
Marques, Melania Genta, Pedro R. Sands, Scott A. Azarbazin, Ali de Melo, Camila [UNIFESP] Taranto-Montemurro, Luigi White, David P. Wellman, Andrew |
author_role |
author |
author2 |
Genta, Pedro R. Sands, Scott A. Azarbazin, Ali de Melo, Camila [UNIFESP] Taranto-Montemurro, Luigi White, David P. Wellman, Andrew |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Marques, Melania Genta, Pedro R. Sands, Scott A. Azarbazin, Ali de Melo, Camila [UNIFESP] Taranto-Montemurro, Luigi White, David P. Wellman, Andrew |
dc.subject.eng.fl_str_mv |
Supine position airway obstruction epiglottis sleep apnea |
topic |
Supine position airway obstruction epiglottis sleep apnea |
description |
Objectives: In some patients, obstructive sleep apnea (OSA) can be resolved with improvement in pharyngeal patency by sleeping lateral rather than supine, possibly as gravitational effects on the tongue are relieved. Here we tested the hypothesis that the improvement in pharyngeal patency depends on the anatomical structure causing collapse, with patients with tongue-related obstruction and epiglottic collapse exhibiting preferential improvements. Methods: Twenty-four OSA patients underwent upper airway endoscopy during natural sleep to determine the pharyngeal structure associated with obstruction, with simultaneous recordings of airflow and pharyngeal pressure. Patients were grouped into three categories based on supine endoscopy: Tongue-related obstruction (posteriorly located tongue, N = 10), non-tongue related obstruction (collapse due to the palate or lateral walls, N = 8), and epiglottic collapse (N = 6). Improvement in pharyngeal obstruction was quantified using the change in peak inspiratory airflow and minute ventilation lateral versus supine. Results: Contrary to our hypothesis, patients with tongue-related obstruction showed no improvement in airflow, and the tongue remained posteriorly located while lateral. Patients without tongue involvement showed modest improvement in airflow (peak flow increased 0.07 L/s and ventilation increased 1.5 L/min). Epiglottic collapse was virtually abolished with lateral positioning and ventilation increased by 45% compared to supine position. Conclusions: Improvement in pharyngeal patency with sleeping position is structure specific, with profound improvements seen in patients with epiglottic collapse, modest effects in those without tongue involvement and-unexpectedly-no effect in those with tongue-related obstruction. Our data refute the notion that the tongue falls back into the airway during sleep via gravitational influences. |
publishDate |
2017 |
dc.date.issued.fl_str_mv |
2017 |
dc.date.accessioned.fl_str_mv |
2020-07-17T14:02:45Z |
dc.date.available.fl_str_mv |
2020-07-17T14:02:45Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
Sleep. Cary, v. 40, n. 3, p. -, 2017. |
dc.identifier.uri.fl_str_mv |
https://repositorio.unifesp.br/handle/11600/54990 http://dx.doi.org/10.1093/sleep/zsx005 |
dc.identifier.issn.none.fl_str_mv |
1550-9109 |
dc.identifier.doi.none.fl_str_mv |
10.1093/sleep/zsx005 |
dc.identifier.wos.none.fl_str_mv |
WOS:000398921100022 |
identifier_str_mv |
Sleep. Cary, v. 40, n. 3, p. -, 2017. 1550-9109 10.1093/sleep/zsx005 WOS:000398921100022 |
url |
https://repositorio.unifesp.br/handle/11600/54990 http://dx.doi.org/10.1093/sleep/zsx005 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
Sleep |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
- |
dc.coverage.none.fl_str_mv |
Cary |
dc.publisher.none.fl_str_mv |
Oxford Univ Press Inc |
publisher.none.fl_str_mv |
Oxford Univ Press Inc |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
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1783460261885116416 |