PMID- 28651794
OWN - NLM
STAT- MEDLINE
DCOM- 20170922
LR  - 20220321
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 152
IP  - 3
DP  - 2017 Sep
TI  - Airflow Shape Is Associated With the Pharyngeal Structure Causing OSA.
PG  - 537-546
LID - S0012-3692(17)31173-X [pii]
LID - 10.1016/j.chest.2017.06.017 [doi]
AB  - BACKGROUND: OSA results from the collapse of different pharyngeal structures 
      (soft palate, tongue, lateral walls, and epiglottis). The structure involved in 
      collapse has been shown to impact non-CPAP OSA treatment. Different inspiratory 
      airflow shapes are also observed among patients with OSA. We hypothesized that 
      inspiratory flow shape reflects the underlying pharyngeal structure involved in 
      airway collapse. METHODS: Subjects with OSA were studied with a pediatric 
      endoscope and simultaneous nasal flow and pharyngeal pressure recordings during 
      natural sleep. The mechanism causing collapse was classified as tongue-related, 
      isolated palatal, lateral walls, or epiglottis. Flow shape was classified 
      according to the degree of negative effort dependence (NED), defined as the 
      percent reduction in inspiratory flow from peak to plateau. RESULTS: Thirty-one 
      subjects with OSA (mean apnea-hypopnea index score +/- SD, 54 +/- 27 events/h) who 
      were 50 +/- 9 years of age were studied. NED was associated with the structure 
      causing collapse (P < .001). Tongue-related obstruction (n = 13) was associated 
      with a small amount of NED (median, 19; interquartile range [IQR], 14%-25%). 
      Moderate NED was found among subjects with isolated palatal collapse (median, 45; 
      IQR, 39%-52%; n = 8) and lateral wall collapse (median, 50; IQR, 44%-64%; n = 8). 
      The epiglottis was associated with severe NED (median, 89; IQR, 78%-91%) and 
      abrupt discontinuities in inspiratory flow (n = 9). CONCLUSIONS: Inspiratory flow 
      shape is influenced by the pharyngeal structure causing collapse. Flow shape 
      analysis may be used as a noninvasive tool to help determine the pharyngeal 
      structure causing collapse.
CI  - Copyright (c) 2017 American College of Chest Physicians. Published by Elsevier Inc. 
      All rights reserved.
FAU - Genta, Pedro R
AU  - Genta PR
AD  - Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pulmonary 
      Division, Heart Institute (InCor), Hospital das Clinicas, University of Sao Paulo 
      School of Medicine, Sao Paulo, Brazil. Electronic address: prgenta@gmail.com.
FAU - Sands, Scott A
AU  - Sands SA
AD  - Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of 
      Allergy, Immunology and Respiratory Medicine and Central Clinical School, The 
      Alfred and Monash University, Melbourne, VIC, Australia.
FAU - Butler, James P
AU  - Butler JP
AD  - Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
FAU - Loring, Stephen H
AU  - Loring SH
AD  - Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical 
      School, Boston, MA.
FAU - Katz, Eliot S
AU  - Katz ES
AD  - Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical 
      School, Boston, MA.
FAU - Demko, B Gail
AU  - Demko BG
AD  - Sleep Apnea Dentists of New England, Weston, MA.
FAU - Kezirian, Eric J
AU  - Kezirian EJ
AD  - USC Caruso Department of Otolaryngology - Head & Neck Surgery, Keck School of 
      Medicine of USC, Los Angeles, CA.
FAU - White, David P
AU  - White DP
AD  - Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
FAU - Wellman, Andrew
AU  - Wellman A
AD  - Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
LA  - eng
GR  - 13POST14770069/AHA_/American Heart Association-American Stroke Association/United 
      States
GR  - P01 HL095491/HL/NHLBI NIH HHS/United States
GR  - R01 HL102321/HL/NHLBI NIH HHS/United States
GR  - R01 HL128658/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20170623
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
SB  - IM
MH  - Adult
MH  - Airway Resistance/physiology
MH  - Bronchoscopy
MH  - Epiglottis/pathology/physiopathology
MH  - Female
MH  - Humans
MH  - Inhalation/*physiology
MH  - Inspiratory Capacity
MH  - Male
MH  - Maximal Respiratory Pressures
MH  - Middle Aged
MH  - Palate/pathology/physiopathology
MH  - Pharynx/*pathology/physiopathology
MH  - Sleep Apnea, Obstructive/*etiology/*pathology/physiopathology
MH  - Tongue/pathology/physiopathology
PMC - PMC5812772
OTO - NOTNLM
OT  - OSA
OT  - flow shape
OT  - site of pharyngeal collapse
EDAT- 2017/06/28 06:00
MHDA- 2017/09/25 06:00
PMCR- 2018/09/01
CRDT- 2017/06/28 06:00
PHST- 2017/02/20 00:00 [received]
PHST- 2017/05/03 00:00 [revised]
PHST- 2017/06/01 00:00 [accepted]
PHST- 2017/06/28 06:00 [pubmed]
PHST- 2017/09/25 06:00 [medline]
PHST- 2017/06/28 06:00 [entrez]
PHST- 2018/09/01 00:00 [pmc-release]
AID - S0012-3692(17)31173-X [pii]
AID - 10.1016/j.chest.2017.06.017 [doi]
PST - ppublish
SO  - Chest. 2017 Sep;152(3):537-546. doi: 10.1016/j.chest.2017.06.017. Epub 2017 Jun 
      23.