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Analysis of anatomical and functional determinants of obstructive sleep apnea

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Abstract

Purpose

Craniofacial abnormalities have an important role in the occurrence of obstructive sleep apnea (OSA) and may be particularly significant in Asian patients, although obesity and functional abnormalities such as reduced lung volume and increased airway resistance also may be important. We conducted simultaneous analyses of their interrelationships to evaluate the relative contributions of obesity, craniofacial structure, pulmonary function, and airway resistance to the severity of Japanese OSA because there are little data in this area.

Methods

A cross-sectional observational study was performed on 134 consecutive Japanese male patients. A sleep study, lateral cephalometry, pulmonary function tests, and impulse oscillometry (IOS) were performed on all patients.

Results

Age, body mass index (BMI), position of the hyoid bone, and proximal airway resistance on IOS (R20) were significantly related to the apnea/hypopnea index (AHI) (p < 0.05) in multiple regression analysis. Subgroup analysis showed that, for moderate-to-severe OSA (AHI ≥ 15 events/h), neck circumference and R20 were predominantly related to AHI, whereas for non-to-mild OSA (AHI < 15 events/h), age and expiratory reserve volume were the predominant determinants. In obese subjects (BMI ≥ 25 kg/m2), alveolar–arterial oxygen tension difference, position of the hyoid bone, and R20 were significantly associated with AHI, whereas age alone was a significant factor in nonobese subjects (BMI < 25 kg/m2).

Conclusions

Aside from age and obesity, anatomical and functional abnormalities are significantly related to the severity of Japanese OSA. Predominant determinants of AHI differed depending on the severity of OSA or the magnitude of obesity.

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References

  1. Hudgel DW (1992) Mechanisms of obstructive sleep apnea. Chest 101:541–549

    Article  PubMed  CAS  Google Scholar 

  2. Ryan CM, Bradley TD (2005) Pathogenesis of obstructive sleep apnea. J Appl Physiol 99:2440–2450

    Article  PubMed  Google Scholar 

  3. Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S (1999) Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J 13:403–410

    Article  PubMed  CAS  Google Scholar 

  4. Yu X, Fujimoto K, Urushibata K, Matsuzawa Y, Kubo K (2003) Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome. Chest 124:212–218

    Article  PubMed  Google Scholar 

  5. Tsuiki S, Isono S, Ishikawa T, Yamashiro Y, Tatsumi K, Nishino T (2008) Anatomical balance of the upper airway and obstructive sleep apnea. Anesthesiology 108:1009–1015

    Article  PubMed  Google Scholar 

  6. Dempsey JA, Skatrud JB, Jacques AJ, Ewanowski SJ, Woodson BT, Hanson PR, Goodman B (2002) Anatomic determinants of sleep-disordered breathing across the spectrum of clinical and nonclinical male subjects. Chest 122:840–851

    Article  PubMed  Google Scholar 

  7. Lee RW, Vasudavan S, Hui DS, Prvan T, Petocz P, Darendeliler MA, Cistulli PA (2010) Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep 33:1075–1080

    PubMed  Google Scholar 

  8. Heinzer RC, Stanchina ML, Malhotra A, Fogel RB, Patel SR, Jordan AS, Schory K, White DP (2005) Lung volume and continuous positive airway pressure requirements in obstructive sleep apnea. Am J Respir Crit Care Med 172:114–117

    Article  PubMed  Google Scholar 

  9. Tagaito Y, Isono S, Remmers JE, Tanaka A, Nishino T (2007) Lung volume and collapsibility of the passive pharynx in patients with sleep-disordered breathing. J Appl Physiol 103:1379–1385

    Article  PubMed  Google Scholar 

  10. Bradley TD, Martinez D, Rutherford R, Lue F, Grossman RF, Moldofsky H, Zamel N, Phillipson EA (1985) Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea. J Appl Physiol 59:1364–1368

    PubMed  CAS  Google Scholar 

  11. Appelberg J, Nordahl G, Janson C (2000) Lung volume and its correlation to nocturnal apnoea and desaturation. Respir Med 94:233–239

    Article  PubMed  CAS  Google Scholar 

  12. Lin CC, Wu KM, Chou CS, Liaw SF (2004) Oral airway resistance during wakefulness in eucapnic and hypercapnic sleep apnea syndrome. Respir Physiol Neurobiol 139:215–224

    Article  PubMed  Google Scholar 

  13. Cao J, Que C, Wang G, He B (2009) Effect of posture on airway resistance in obstructive sleep apnea–hypopnea syndrome by means of impulse oscillation. Respiration 77:38–43

    Article  PubMed  Google Scholar 

  14. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90:47–112

    Article  PubMed  CAS  Google Scholar 

  15. Mayer P, Pepin JL, Bettega G, Veale D, Ferretti G, Deschaux C, Levy P (1996) Relationship between body mass index, age and upper airway measurements in snorers and sleep apnoea patients. Eur Respir J 9:1801–1809

    Article  PubMed  CAS  Google Scholar 

  16. Salome CM, King GG, Berend N (2010) Physiology of obesity and effects on lung function. J Appl Physiol 108:206–211

    Article  PubMed  Google Scholar 

  17. Zerah F, Harf A, Perlemuter L, Lorino H, Lorino AM, Atlan G (1993) Effects of obesity on respiratory resistance. Chest 103:1470–1476

    Article  PubMed  CAS  Google Scholar 

  18. Watson RA, Pride NB (2005) Postural changes in lung volumes and respiratory resistance in subjects with obesity. J Appl Physiol 98:512–517

    Article  PubMed  CAS  Google Scholar 

  19. Ohdaira F, Nakamura K, Nakayama H, Satoh M, Ohdaira T, Nakamata M, Kohno M, Iwashima A, Onda A, Kobayashi Y, Fujimori K, Kiguchi T, Izumi S, Kobayashi T, Shinoda H, Takahashi S, Gejyo F, Yamamoto M (2007) Demographic characteristics of 3,659 Japanese patients with obstructive sleep apnea–hypopnea syndrome diagnosed by full polysomnography: associations with apnea–hypopnea index. Sleep Breath 11:93–101

    Article  PubMed  Google Scholar 

  20. Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. National Institutes of Health, Washington

    Google Scholar 

  21. Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  22. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J (2005) Standardisation of spirometry. Eur Respir J 26:319–338

    Article  PubMed  CAS  Google Scholar 

  23. Hellinckx J, Cauberghs M, De Boeck K, Demedts M (2001) Evaluation of impulse oscillation system: comparison with forced oscillation technique and body plethysmography. Eur Respir J 18:564–570

    Article  PubMed  CAS  Google Scholar 

  24. Oostveen E, MacLeod D, Lorino H, Farre R, Hantos Z, Desager K, Marchal F (2003) The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J 22:1026–1041

    Article  PubMed  CAS  Google Scholar 

  25. Takeda T, Oga T, Niimi A, Matsumoto H, Ito I, Yamaguchi M, Matsuoka H, Jinnai M, Otsuka K, Oguma T, Nakaji H, Chin K, Mishima M (2010) Relationship between small airway function and health status, dyspnea and disease control in asthma. Respiration 80:120–126

    Article  PubMed  Google Scholar 

  26. Haruna A, Oga T, Muro S, Ohara T, Sato S, Marumo S, Kinose D, Terada K, Nishioka M, Ogawa E, Hoshino Y, Hirai T, Chin K, Mishima M (2010) Relationship between peripheral airway function and patient-reported outcomes in COPD: a cross-sectional study. BMC Pulm Med 10:10

    Article  PubMed  Google Scholar 

  27. Goldman MD, Saadeh C, Ross D (2005) Clinical applications of forced oscillation to assess peripheral airway function. Respir Physiol Neurobiol 148:179–194

    Article  PubMed  Google Scholar 

  28. Bédard M, Martin NJ, Krueger P, Brazil K (2000) Assessing reproducibility of data obtained with instruments based on continuous measurements. Exp Aging Res 26:353–365

    Article  PubMed  Google Scholar 

  29. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM (2002) Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 162:893–900

    Article  PubMed  Google Scholar 

  30. Pecora NG, Baccetti T, McNamara JA Jr (2008) The aging craniofacial complex: a longitudinal cephalometric study from late adolescence to late adulthood. Am J Orthod Dentofacial Orthop 134:496–505

    Article  PubMed  Google Scholar 

  31. Janssens JP (2005) Aging of the respiratory system: impact on pulmonary function tests and adaptation to exertion. Clin Chest Med 26:469–484

    Article  PubMed  Google Scholar 

  32. Watanabe T, Isono S, Tanaka A, Tanzawa H, Nishino T (2002) 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 165:260–265

    PubMed  Google Scholar 

  33. Van de Graaff WB (1988) Thoracic influence on upper airway patency. J Appl Physiol 65:2124–2131

    PubMed  Google Scholar 

  34. Michels A, Decoster K, Derde L, Vleurinck C, Van de Woestijne KP (1991) Influence of posture on lung volumes and impedance of respiratory system in healthy smokers and nonsmokers. J Appl Physiol 71:294–299

    PubMed  CAS  Google Scholar 

  35. Lederer DJ, Jelic S, Basner RC, Ishizaka A, Bhattacharya J (2009) Circulating KL-6, a biomarker of lung injury, in obstructive sleep apnoea. Eur Respir J 33:793–796

    Article  PubMed  CAS  Google Scholar 

  36. Aihara K, Oga T, Harada Y, Chihara Y, Handa T, Tanizawa K, Watanabe K, Tsuboi T, Hitomi T, Mishima M, Chin K (2011) Comparison of biomarkers of subclinical lung injury in obstructive sleep apnea. Respir Med 105(6):939–945

    Article  PubMed  Google Scholar 

  37. Guilleminault C, Riley R, Powell N (1984) Obstructive sleep apnea and cephalometric roentgenograms. Am Rev Respir Dis 130:145–146

    PubMed  CAS  Google Scholar 

  38. Maltais F, Carrier G, Cormier Y, Series F (1991) Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea. Thorax 46:419–423

    Article  PubMed  CAS  Google Scholar 

  39. Begle RL, Badr S, Skatrud JB, Dempsey JA (1990) Effect of lung inflation on pulmonary resistance during NREM sleep. Am Rev Respir Dis 141:854–860

    PubMed  CAS  Google Scholar 

  40. White DP (2005) Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med 172:1363–1370

    Article  PubMed  Google Scholar 

  41. Verbraecken JA, De Backer WA (2009) Upper airway mechanics. Respiration 78:121–133

    Article  PubMed  Google Scholar 

  42. Shigeta Y, Ogawa T, Ando E, Clark GT, Enciso R (2011) Influence of tongue/mandible volume ratio on oropharyngeal airway in Japanese male patients with obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111:239–243

    Article  PubMed  Google Scholar 

  43. Saigusa H, Suzuki M, Higurashi N, Kodera K (2009) Three-dimensional morphological analyses of positional dependence in patients with obstructive sleep apnea syndrome. Anesthesiology 110:885–890

    Article  PubMed  Google Scholar 

Download references

Role of funding sources

Kazuo Chin has received grants from the Japanese Ministry of Education, Culture, Sports, Science and Technology (nos. 20590921 and 22590760), Respiratory Failure Research Group and Health Science Research Grants (Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus) from the Ministry of Health, Labor and Welfare of Japan, and the Japan Vascular Disease Research Foundation.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Kensaku Aihara, Yuka Harada, Yuichi Chihara, Tomohiro Handa, Kiminobu Tanizawa, Kizuku Watanabe & Michiaki Mishima

  2. Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Toru Oga, Takefumi Hitomi, Tomomasa Tsuboi & Kazuo Chin

Authors
  1. Kensaku Aihara
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  2. Toru Oga
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  3. Yuka Harada
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  11. Kazuo Chin
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Correspondence to Toru Oga.

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Aihara, K., Oga, T., Harada, Y. et al. Analysis of anatomical and functional determinants of obstructive sleep apnea. Sleep Breath 16, 473–481 (2012). https://doi.org/10.1007/s11325-011-0528-7

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  • DOI: https://doi.org/10.1007/s11325-011-0528-7

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