Transverse Maxillary Deficiency Predicts Increased Upper Airway Collapsibility during Drug-Induced Sleep Endoscopy

Thuler E.; Seay E.G.; Woo J.; Lee J.; Jafari N.; Keenan B.T.; Dedhia R.C.; Schwartz A.R. · Otolaryngology - Head and Neck Surgery (United States) (2023) · DOI: 10.1002/ohn.258

Resumen

Objective: To examine the relationship between craniofacial skeletal anatomy and objective measures of pharyngeal collapse obtained during drug-induced sleep endoscopy. We hypothesized that transverse maxillary deficiency and an increased pharyngeal length will be associated with higher levels of pharyngeal collapsibility. Study Design: Cross-sectional analysis in a prospective cohort. Setting: University Hospital. Methods: A cross-sectional analysis was conducted in a cohort of consecutive patients from the positive airway pressure (PAP) alternatives clinic who underwent computed tomography (CT) analysis and drug-induced sleep endoscopy for characterization of upper airway collapsibility. PAP titration was used to determine pharyngeal critical pressure (PCRIT) and pharyngeal opening pressure (PhOP). CT metrics included: Transverse maxillary dimensions (interpremolar and intermolar distances) and pharyngeal length (posterior nasal spine to hyoid distance). Results: The cohort (n = 103) of severe obstructive sleep apnea (Apnea and Hipopnea Index 32.1 ± 21.3 events/h) was predominantly male (71.8%), Caucasian (81.6%), middle-aged (54.4 ± 14.3 years), and obese (body mass index [BMI] = 30.0 ± 4.9 kg/m2). Reduced transverse maxillary dimensions were associated with higher PCRIT (intermolar distance: β [95% confidence interval, CI] = −.25 [−0.14, −0.36] cmH2O/mm; p =.03) and PhOP (Interpremolar distance: β = −.25 [−0.14, −0.36] cmH2O/mm; p =.02). Longer pharyngeal length was also associated with higher PCRIT (β =.11 [0.08, 0.14] cmH2O/mm, p =.04) and PhOP (β [95% CI] =.06 [0.03, 0.09] cmH2O/mm, p =.04). These associations persisted after adjustments for sex, age, height, and BMI. Conclusion: Our results further the concept that skeletal restriction in the transverse dimension and hyoid descent are associated with elevations in pharyngeal collapsibility during sleep, suggesting a role of transverse deficiency in the pathogenesis of airway obstruction.

Instituciones: Universidad Peruana Cayetano Heredia