J Rhinol.  2019 May;26(1):21-25. 10.18787/jr.2019.26.1.21.

Analysis of Obstruction Site in Obstructive Sleep Apnea Patients Based on Videofluoroscopy

• Choi HR
• Han K
• Lee J
• Hong SC
• Kim JK
• Cho JH

• KMID: 2449024
• DOI: http://doi.org/10.18787/jr.2019.26.1.21

Abstract

BACKGROUND AND OBJECTIVES
Upper airway obstruction can occur at the soft palate, tongue base, or epiglottis among obstructive sleep apnea (OSA) patients. Detection of these obstruction sites is very important for choosing a treatment modality for OSA. The purpose of this study was to evaluate the obstruction site of OSA patients and its association with mouth opening and head position.
SUBJECTS AND METHOD
Forty-eight consecutive patients with suspicion of OSA were enrolled and underwent videofluoroscopy to evaluate the obstruction site, as well as polysomnography. Obstruction site, mouth opening, and head position were evaluated on videofluoroscopy, and their association was analyzed.
RESULTS
According to the videofluoroscopy, 47 (97.9%) of 48 patients showed an obstruction in the soft palate, while 24 (50.0%) were located in the tongue base and 14 (29.2%) in the epiglottis. Multiple obstructions were observed in many patients. Mean apnea-hypopnea index was higher among patients with tongue base obstruction (42.3±26.7) compared to those without obstruction (26.4±21.2, p=0.058). However, epiglottis obstruction did not influence apnea-hypopnea index. Mouth opening did not show any association with tongue base obstruction (p=0.564), while head flexion was highly associated (p<0.001).
CONCLUSION
Half of patients with OSA have tongue base obstruction, which worsens the apnea-hypopnea index. Head flexion is associated with tongue base obstruction, while mouth opening is not.

Keyword

Obstructive sleep apnea; Tongue base; Videofluoroscopy

MeSH Terms

Airway Obstruction
Epiglottis
Head
Humans
Methods
Mouth
Palate, Soft
Polysomnography
Sleep Apnea, Obstructive*
Tongue

Figure

• 

  Fig. 1 A: Angle of head position. It is defined by the intersection of two lines. One connects the midpoint of the pituitary fossa to the nasion and the other line is posteriorly tangent to the cervical vertebra through the second and the fourth. B: Angle of mouth opening. It is formed by the intersection of lines drawn from the maxillary incisor to the glenoid fossa and from the glenoid fossa to the mandibular incisor.

• 

  Fig. 2 Distribution of obstruction sites.

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