Evaluation of the upper airway in obstructive sleep apnoea.
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Date
2010-02
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Abstract
The evaluation of the upper airway (UA) includes the physical examination of pharyngeal structures
and a number of imaging techniques that vary from the mostly used lateral cephalometry and computed
tomography to more sophisticated methods such as tri-dimensional magnetic resonance image (MRI).
Other complex techniques addressing UA collapsibility assessed by measurement of pharyngeal critical
pressure and negative expiratory pressure however are not routinely performed. These methods provide
information about anatomic abnormalities and the level of pharyngeal narrowing or collapse while the
patient is awake or asleep. Data suggest that individual patients have different patterns of UA narrowing.
So, the best method for evaluating obstruction during obstructive events remains controversial. In
general, in clinical practice physical examination including a systematic evaluation of facial morphology,
mouth, nasal cavity and the pharynx as well as simple imaging techniques such as nasopharyngoscopy
and cephalometry have been more routinely utilized. Findings associated with obstructive sleep apnoea
(OSA) are UA narrowing by the lateral pharyngeal walls and enlargements of tonsils, uvula and tongue.
Additionally cephalometry identifies the most significant craniofacial characteristics associated with
this disease. MRI studies demonstrated that lateral narrowing of UA in OSA is due to parapharyngeal
muscle hypertrophy and/or enlargement of non adipose soft tissues.
The upper airway evaluation has indubitably contributed to understand the pathophysiology and the
diagnosis of OSA and snoring. Additionally, it also helps to identify the subjects with increased OSA risk
as well as to select the more appropriate modality of treatment, especially for surgical procedures.
Description
Keywords
Acoustic reflection, nasopharyngoscopy, negative expiratory pressure, pharyngeal collapse, OSA, upper airway
Citation
Togeiro Sonia Maria G P, Chaves Jr Cauby M, Palombini Luciana, Tufik Sergio, Hora Francisco, Nery Luiz Eduardo. Evaluation of the upper airway in obstructive sleep apnoea. Indian Journal of Medical Research. 2010 Feb; 131(2): 230-235.