Faculty Collaboration Database

Phenotypes of Velopharyngeal Tube Law in Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2025 Jan;172(1):336-345

Date

10/03/2024

Pubmed ID

39360341

Pubmed Central ID

PMC11698636

DOI

10.1002/ohn.997

Scopus ID

2-s2.0-85205393980 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

OBJECTIVE: The biomechanics of upper airway collapse in obstructive sleep apnea (OSA) remains poorly understood. The goal of this study is to compare the area-pressure relationship (tube law) of the velopharynx at peak inspiration and peak expiration.

STUDY DESIGN: Cross-sectional.

SETTING: Academic tertiary medical center.

METHODS: The velopharyngeal tube law was quantified in a convenience sample of 20 OSA patients via step reductions in nasal mask pressure during drug induced sleep endoscopy (DISE). The velopharyngeal airspace cross-sectional area was estimated from endoscopy while luminal pressure was recorded with a catheter. The tube law was quantified for nasal mask pressures from 14 to 0 cmH₂O at peak inspiration and at peak expiration in all patients. The tube law was also quantified during the breathing cycle at a constant nasal mask pressure of 4 cmH₂O in 3 patients representing different phenotypes.

RESULTS: Velopharyngeal compliance (the slope of the tube law) was not statistically different in the peak inspiration versus peak expiration tube laws. Three phenotypes were observed, namely inspiratory collapse (phenotype 1), expiratory collapse (phenotype 2 = palatal prolapse), and a mostly stable airway during inspiration and expiration that collapsed as CPAP was reduced (phenotype 3).

CONCLUSION: Velopharyngeal compliance is not significantly different at peak inspiration and peak expiration, which suggests that muscle tone is low when luminal pressure is above the closing pressure. Additional studies are needed to investigate how different phenotypes of velopharyngeal collapse may affect therapeutic outcomes.

Author List

Kumar D, Woodson BT, Garcia GJM

Author

Guilherme Garcia PhD Assistant Professor in the Biomedical Engineering department at Medical College of Wisconsin

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

Adult
Biomechanical Phenomena
Cross-Sectional Studies
Endoscopy
Exhalation
Female
Humans
Male
Middle Aged
Pharynx
Phenotype
Polysomnography
Sleep Apnea, Obstructive