Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Objective Evaluation of Oral and Pharyngeal Areas in Autopsy Cases of Obstructive Sleep Apnea Syndrome via Postmortem CT

Author(s): Akiko Takeuchi, Hideki Hyodoh, Shigeki Jin, Satoshi Tanaka, Manabu Murakami, Kazuyuki Minowa and Kotaro Matoba*

Volume 20, 2024

Published on: 06 June, 2023

Article ID: e280323215022 Pages: 7

DOI: 10.2174/1573405620666230328082804

Price: $65

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) can cause sudden death during sleep. Previous findings have suggested that OSAS development is related to maxillofacial morphology. Evaluation of facial morphology can determine the risk of developing the disease, and establishing an objective method to assess the underlying etiology of OSAS-related death would be advantageous.

Objective: The objective of this study is to determine the key features of obstructive sleep apnea syndrome (OSAS) using postmortem oral and pharyngeal computed tomography (CT).

Methods: We retrospectively assessed autopsy cases of patients with (n=25) and without (n=25) OSAS-related death. We used oral and pharyngeal CT images to compare the oral and pharyngeal cavity volume (OPCV), oral and pharyngeal soft tissue volume (OPSV), oral and pharyngeal air space volume (OPAV), and OPAV to OPCV ratio (%air). Receiver operating curve (ROC) analysis was used to determine the accuracy of OSAS prediction. We assessed participants with body mass index (BMI) values within the normal range.

Results: Among the 50 subjects, we observed significant between-group differences in OPSV, OPAV, and % air, whereas there were significant betweengroup differences in OPSV and %air among 28 subjects with normal BMI values. Both comparisons suggested that OSAS-related death was associated with low %air and high OPSV values.

Conclusion: The % air and OPSV are useful for assessing postmortem oropharyngeal CT images. OSAS-related sudden death is likely when %air and OPSV values are ≤20.1% and ≥127.2 ml, respectively. Among those with normal BMI values, % air and OPSV values of ≤22.8% and ≥111.5 ml, respectively, predict OSAS-related sudden death.

[1]
Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med 2005; 352(12): 1206-14.
[http://dx.doi.org/10.1056/NEJMoa041832] [PMID: 15788497]
[2]
Uemura K, Harada K, Shiotani A, et al. Obesity-sleep apnea (Pickwickian) syndrome: Autopsy findings and a medicolegal review. Leg Med 2000; 2(1): 36-41.
[http://dx.doi.org/10.1016/S1344-6223(00)80007-3] [PMID: 12935464]
[3]
Zhang M, Li L, Fowler D, et al. Causes of sudden death in patients with obstructive sleep apnea. J Forensic Sci 2013; 58(5): 1171-4.
[http://dx.doi.org/10.1111/1556-4029.12220] [PMID: 23865847]
[4]
Clinical practice guidelines for sleep apnea syndrome (SAS). Japan: Nankodo: The Japanese Respiratory Society 2020.
[5]
Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000; 284(23): 3015-21.
[http://dx.doi.org/10.1001/jama.284.23.3015] [PMID: 11122588]
[6]
Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: The sleep heart health study. Arch Intern Med 2002; 162(8): 893-900.
[http://dx.doi.org/10.1001/archinte.162.8.893] [PMID: 11966340]
[7]
Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004; 291(16): 2013-6.
[http://dx.doi.org/10.1001/jama.291.16.2013] [PMID: 15113821]
[8]
Yang L, Samarasinghe YP, Kane P, Amiel SA, Aylwin SJB. Visceral adiposity is closely correlated with neck circumference and represents a significant indicator of insulin resistance in WHO grade III obesity. Clin Endocrinol 2010; 73(2): 197-200.
[PMID: 20050862]
[9]
Tangugsorn V, Skatvedt O, Krogstad O, Lyberg T. Obstructive sleep apnoea: A cephalometric study. Part I. Cervico-craniofacial skeletal morphology. Eur J Orthod 1995; 17(1): 45-56.
[http://dx.doi.org/10.1093/ejo/17.1.45] [PMID: 7737345]
[10]
Bacon WH, Krieger J, Turlot JC, Stierle JL. Craniofacial characteristics in patients with obstructive sleep apneas syndrome. Cleft Palate J 1988; 25(4): 374-8.
[PMID: 3203468]
[11]
Hui DSC, Ko FWS, Chu ASY, et al. Cephalometric assessment of craniofacial morphology in Chinese patients with obstructive sleep apnoea. Respir Med 2003; 97(6): 640-6.
[http://dx.doi.org/10.1053/rmed.2003.1494] [PMID: 12814148]
[12]
Endo S, Mataki S, Kurosaki N. Cephalometric evaluation of craniofacial and upper airway structures in Japanese patients with obstructive sleep apnea. J Med Dent Sci 2003; 50(1): 109-20.
[PMID: 12715927]
[13]
Ong KC, Clerk AA. Comparison of the severity of sleep-disordered breathing in Asian and Caucasian patients seen at a sleep disorders center. Respir Med 1998; 92(6): 843-8.
[http://dx.doi.org/10.1016/S0954-6111(98)90386-9] [PMID: 9850368]
[14]
Li KK, Kushida C, Powell NB, Riley RW, Guilleminault C. Obstructive sleep apnea syndrome: A comparison between Far-East Asian and white men. Laryngoscope 2000; 110(10): 1689-93.
[http://dx.doi.org/10.1097/00005537-200010000-00022] [PMID: 11037826]
[15]
Liua Y, Lowea AA, Zengb X, Fub M, Fleethamc JA. Cephalometric comparisons between Chinese and Caucasian patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2000; 117(4): 479-85.
[http://dx.doi.org/10.1016/S0889-5406(00)70169-7] [PMID: 10756275]
[16]
Lee RWW, Vasudavan S, Hui DS, et al. Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep 2010; 33(8): 1075-80.
[http://dx.doi.org/10.1093/sleep/33.8.1075] [PMID: 20815189]
[17]
Momomura S, Akashiba T, Asanoi H, et al. Guideline for diagnosis and treatment of sleep disordered breathing in cardiovascular disease. Circ J 2010; 74(S2): 963-1084.
[18]
Lowe AA, Gionhaku N, Takeuchi K, Fleetham JA. Three-dimensional CT reconstructions of tongue and airway in adult subjects with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1986; 90(5): 364-74.
[http://dx.doi.org/10.1016/0889-5406(86)90002-8] [PMID: 3465231]
[19]
Ahn SH, Kim J, Min HJ, et al. Tongue volume influences lowest oxygen saturation but not apnea-hypopnea index in obstructive sleep apnea. PLoS One 2015; 10(8): e0135796.
[http://dx.doi.org/10.1371/journal.pone.0135796] [PMID: 26280546]
[20]
Arisaka T. Upper respiratory tract morphological evaluation (cephalogram and 3DCT) (Topics Surveillance around sleeping medical care) UPDATE: The latest technology and evaluation method. Jpn J Sleep Med 2014; 8(4): 577-84.
[21]
Yasui K, Hasegawa Y, Maeda N, et al. An autopsy case of multiple system atrophy who died of CO2 narcosis with severe sleep apnea syndrome. Neuropathology 2013; 33(3): 361.
[22]
Takeuchi A, Hyodoh H, Matoba K, Murakami M, Kudo K, Minowa K. Evaluation of oral air space volume in obstructive sleep apnea syndrome using clinical and postmortem CT imaging. Oral Radiol 2022; 38(1): 29-36.
[http://dx.doi.org/10.1007/s11282-021-00520-y] [PMID: 33743131]
[23]
Abramson ZR, Susarla S, Tagoni JR, Kaban L. Three-dimensional computed tomographic analysis of airway anatomy. J Oral Maxillofac Surg 2010; 68(2): 363-71.
[http://dx.doi.org/10.1016/j.joms.2009.09.086] [PMID: 20116709]
[24]
Ogawa T, Enciso R, Shintaku WH, Clark GT. Evaluation of cross-section airway configuration of obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103(1): 102-8.
[http://dx.doi.org/10.1016/j.tripleo.2006.06.008] [PMID: 17178502]
[25]
Rodenstein DO, Dooms G, Thomas Y, et al. Pharyngeal shape and dimensions in healthy subjects, snorers, and patients with obstructive sleep apnoea. Thorax 1990; 45(10): 722-7.
[http://dx.doi.org/10.1136/thx.45.10.722] [PMID: 2247861]
[26]
Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2017; 13(3): 479-504.
[http://dx.doi.org/10.5664/jcsm.6506] [PMID: 28162150]
[27]
Anandam A, Patil M, Akinnusi M, Jaoude P, El-Solh AA. Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: An observational study. Respirology 2013; 18(8): 1184-90.
[http://dx.doi.org/10.1111/resp.12140] [PMID: 23731062]
[28]
Akar Bayram N. Prevalence of cardiac arrhythmia in obstructive sleep apnea syndrome. Turk J Med Sci 2010; 40(6): 843-50.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy