Palatine Tonsil Size Predicts Upper Airway Obstruction in Adults with Obstructive Sleep Apnea
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Objectives: Drug-induced sleep endoscopy (DISE) is widely used to diagnose obstructive sleep apnea syndrome (OSAS). Palatine tonsil hypertrophy is a frequently encountered potential source of upper airway obstruction. Here, we determined whether the pre-surgery size of the palatine tonsil could be used to predict the extent and pattern of upper airway obstruction during DISE of adults with OSA. Materials and Methods: We retrospectively evaluated 268 patients (mean age 42.80±12.34 years, range 17–73 years) who underwent polysomnography and were diagnosed with OSAS in a single medical center from 2013 to 2020. The Brodsky tonsil scores of all subjects were obtained via physical examination. DISE proceeded with each patient supine. The extent of obstruction was evaluated by dividing the upper airway into retropalatal and retrolingual levels (the Koo's DISE classification system). Data were analyzed via simple linear regression. A p<0.05 was considered statistically significant. Results: We found relationships between the Brodsky tonsil score and the extents of obstruction at the retropalatal level. A significantly negative relationship between the score and retropalatal anteroposterior collapse was apparent (slope coefficient –0.115, p<0.05), as well as a significantly positive relationship between the score and retropalatal lateral collapse (slope coefficient 0.274, p<0.05). However, at the retrolingual level, no significant relationship was apparent between the Brodsky score and the extent of obstruction (p>0.05). Conclusion: In adult patients with OSA, as the palatine tonsil size increased, lateral pharyngeal wall obstruction at the retropalatal level became more severe, and the pattern of upper airway collapse at that level tended to be lateral rather than anteroposterior or concentric.
Abstract
Background and Objectives: Drug-induced sleep endoscopy (DISE) is widely used to diagnose obstructive sleep apnea syndrome (OSAS). Palatine tonsil hypertrophy is a frequently encountered potential source of upper airway obstruction. Here, we determined whether the pre-surgery size of the palatine tonsil could be used to predict the extent and pattern of upper airway obstruction during DISE of adults with OSA. Materials and Methods: We retrospectively evaluated 268 patients (mean age 42.80±12.34 years, range 17–73 years) who underwent polysomnography and were diagnosed with OSAS in a single medical center from 2013 to 2020. The Brodsky tonsil scores of all subjects were obtained via physical examination. DISE proceeded with each patient supine. The extent of obstruction was evaluated by dividing the upper airway into retropalatal and retrolingual levels (the Koo's DISE classification system). Data were analyzed via simple linear regression. A p<0.05 was considered statistically significant. Results: We found relationships between the Brodsky tonsil score and the extents of obstruction at the retropalatal level. A significantly negative relationship between the score and retropalatal anteroposterior collapse was apparent (slope coefficient –0.115, p<0.05), as well as a significantly positive relationship between the score and retropalatal lateral collapse (slope coefficient 0.274, p<0.05). However, at the retrolingual level, no significant relationship was apparent between the Brodsky score and the extent of obstruction (p>0.05). Conclusion: In adult patients with OSA, as the palatine tonsil size increased, lateral pharyngeal wall obstruction at the retropalatal level became more severe, and the pattern of upper airway collapse at that level tended to be lateral rather than anteroposterior or concentric.
참고문헌 (20)
- Franklin KA, "Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea", J Thorac Dis, 7(8), pp.1311~1322 (2015)
- Punjabi NM, "The epidemiology of adult obstructive sleep apnea", Proc Am Thorac Soc, 5(2), pp.136~143 (2008)
- Kezirian EJ, "Drug-induced sleep endoscopy : the VOTE classification", Eur Arch Otorhinolarnygol, 268(8), pp.1233~1236 (2011)
- Croft CB, "Sleep nasendoscopy : a technique of assessment in snoring and obstructive sleep apnoea", Clin Otolaryngol Allied Sci, 16(5), pp.504~509 (1991)
- Rabelo FAW, "Polysomnographic evaluation of propofol-induced sleep in patients with respiratory sleep disorders and controls", Laryngoscope, 123(9), pp.2300~2305 (2013)
- Fernández-Julián E, "Surgical planning after sleep versus awake techniques in patients with obstructive sleep apnea", Laryngoscope, 124(8), pp.1970~1974 (2014)
- Rodriguez-Bruno K, "Test-retest reliability of drug-induced sleep endoscopy", Otolaryngol Head Neck Surg, 140(5), pp.646~651 (2009)
- Jara SM, "Association of palatine tonsil size and obstructive sleep apnea in adults", Laryngoscope, 128(4), pp.1002~1006 (2018)
- Cahali MB, "Tonsil volume, tonsil grade and obstructive sleep apnea: is there any meaningful correlation?", Clinics(Sao Paulo), 66(8), pp.1347~1352 (2011)
- Holmlund T, "Tonsillectomy in adults with obstructive sleep apnea", Laryngoscope, 126(12), pp.2859~2862 (2016)
- Brodsky L, "Modern assessment of tonsils and adenoids", Pediatr Clin North Am, 36(6), pp.1551~1569 (1989)
- Koo SK, "Inter-rater reliability between experienced and inexperienced otolaryngologists using Koo’s drug-induced sleep endoscopy classification system", Eur Arch Otorhinolaryngol, 276(5), pp.1525~1531 (2019)
- Baugh RF, "Clinical practice guideline : tonsillectomy in children", Otolaryngol Head Neck Surg, 144(1 Suppl), pp.S1~S30 (2011)
- Miller C, "Clinically small tonsils are typically not obstructive in children during drug-induced sleep endoscopy", Laryngoscope, 127(8), pp.1943~1949 (2017)
- Koo SK, "Comparison of snoring sounds between natural and drug-induced sleep recorded using a smartphone", Auris Nasus Larynx, 45(4), pp.777~782 (2018)
- Vanderveken OM, "Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea", J Clin Sleep Med, 9(5), pp.433~438 (2013)
- Koo SK, "Analysis of obstruction site in obstructive sleep apnea syndrome patients by drug induced sleep endoscopy", Am J Otolaryngol, 34(6), pp.626~630 (2013)
- Ravesloot MJL, "One hundred consecutive patients undergoing drug-induced sleep endoscopy : results and evaluation", Laryngoscope, 121(12), pp.2710~2716 (2011)
- Lin HY, "Comparison of findings between clinical examinations and drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome", Int J Environ Res Public Health, 17(17), pp.6041~ (2020)
- Isono S, "Influences of head positions and bite opening on collapsibility of the passive pharynx", J Appl Physiol, 97(1), pp.339~346 (2004)