Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse

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dc.citation.issue3
dc.citation.volume40
dc.contributor.authorMarques, Melania
dc.contributor.authorGenta, Pedro R.
dc.contributor.authorSands, Scott A.
dc.contributor.authorAzarbazin, Ali
dc.contributor.authorde Melo, Camila [UNIFESP]
dc.contributor.authorTaranto-Montemurro, Luigi
dc.contributor.authorWhite, David P.
dc.contributor.authorWellman, Andrew
dc.coverageCary
dc.date.accessioned2020-07-17T14:02:45Z
dc.date.available2020-07-17T14:02:45Z
dc.date.issued2017
dc.description.abstractObjectives: 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.en
dc.description.affiliationDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Med, Boston, MA USA
dc.description.affiliationHarvard Med Sch, Brigham & Womens Hosp, Dept Neurol, Boston, MA USA
dc.description.affiliationUniv Sao Paulo, Sch Med, Hosp Clin, Pulm Div,Heart Inst InCor, Sao Paulo, Brazil
dc.description.affiliationAlfred, Dept Allergy Immunol & Resp Med, Melbourne, Australia
dc.description.affiliationAlfred, Cent Clin Sch, Melbourne, Australia
dc.description.affiliationMonash Univ, Melbourne, Vic, Australia
dc.description.affiliationUniv Fed Sao Paulo, UNIFESP, Dept Psychobiol, Sao Paulo, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, UNIFESP, Dept Psychobiol, Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipApnicure Inc.
dc.description.sponsorshipPhilips Respironics
dc.format.extent-
dc.identifierhttp://dx.doi.org/10.1093/sleep/zsx005
dc.identifier.citationSleep. Cary, v. 40, n. 3, p. -, 2017.
dc.identifier.doi10.1093/sleep/zsx005
dc.identifier.issn1550-9109
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/54990
dc.identifier.wosWOS:000398921100022
dc.language.isoeng
dc.publisherOxford Univ Press Inc
dc.relation.ispartofSleep
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectSupine positionen
dc.subjectairway obstructionen
dc.subjectepiglottisen
dc.subjectsleep apneaen
dc.titleEffect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapseen
dc.typeinfo:eu-repo/semantics/article
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