Faculty Collaboration Database

Anatomical determinants of upper airway collapsibility in obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2023 Apr;68:101741

Date

01/13/2023

Pubmed ID

36634409

DOI

10.1016/j.smrv.2022.101741

Scopus ID

2-s2.0-85146096954 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

Upper airway (UA) collapsibility is one of the key factors that determine the severity of obstructive sleep apnea (OSA). Interventions for OSA are aimed at reducing UA collapsibility, but selecting the optimal alternative intervention for patients who fail CPAP is challenging because currently no validated method predicts how anatomical changes affect UA collapsibility. The gold standard objective measure of UA collapsibility is the pharyngeal critical pressure (P_crit). A systematic literature review and meta-analysis were performed to identify the anatomical factors with the strongest correlation with P_crit. A search using the PRISMA methodology was performed on PubMed for English language scientific papers that correlated P_crit to anatomic variables and OSA severity as measured by the apnea-hypopnea index (AHI). A total of 29 papers that matched eligibility criteria were included in the quantitative synthesis. The meta-analysis suggested that AHI has only a moderate correlation with P_crit (estimated Pearson correlation coefficient r = 0.46). The meta-analysis identified four key anatomical variables associated with UA collapsibility, namely hyoid position (r = 0.53), tongue volume (r = 0.51), pharyngeal length (r = 0.50), and waist circumference (r = 0.49). In the future, biomechanical models that quantify the relative importance of these anatomical factors in determining UA collapsibility may help identify the optimal intervention for each patient. Many anatomical and structural factors such as airspace cross-sectional areas, epiglottic collapse, and palatal prolapse have inadequate data and require further research.

Author List

Hartfield PJ, Janczy J, Sharma A, Newsome HA, Sparapani RA, Rhee JS, Woodson BT, Garcia GJM

Authors

Guilherme Garcia PhD Assistant Professor in the Biomedical Engineering department at Medical College of Wisconsin
John S. Rhee MD Chair, Professor in the Otolaryngology department at Medical College of Wisconsin
Rodney Sparapani PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Humans
Nose
Pharynx
Polysomnography
Sleep Apnea, Obstructive
Tongue