Airflow Shape Is Associated With the Pharyngeal Structure Causing OSA

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorGENTA, Pedro R.
dc.contributor.authorSANDS, Scott A.
dc.contributor.authorBUTLER, James P.
dc.contributor.authorLORING, Stephen H.
dc.contributor.authorKATZ, Eliot S.
dc.contributor.authorDEMKO, B. Gail
dc.contributor.authorKEZIRIAN, Eric J.
dc.contributor.authorWHITE, David P.
dc.contributor.authorWELLMAN, Andrew
dc.date.accessioned2017-10-24T13:23:46Z
dc.date.available2017-10-24T13:23:46Z
dc.date.issued2017
dc.description.abstractBACKGROUND: 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.
dc.description.indexMEDLINE
dc.description.sponsorshipNational Institutes of Health [R01 HL102321, P01 HL 095491]
dc.description.sponsorshipPhilips Respironics
dc.description.sponsorshipCoordination for the Improvement of Higher Education Personnel, FAPESP
dc.description.sponsorshipAmerican Heart Association [13POST14770069, 15SDG25890059]
dc.description.sponsorshipNational Health and Medical Research Council (NHMRC) of Australia NHMRC Early Career Fellowship [1053201]
dc.description.sponsorshipR.G. Menzies award
dc.identifier.citationCHEST, v.152, n.3, p.537-546, 2017
dc.identifier.doi10.1016/j.chest.2017.06.017
dc.identifier.issn0012-3692
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/22143
dc.language.isoeng
dc.publisherELSEVIER SCIENCE BV
dc.relation.ispartofChest
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER SCIENCE BV
dc.subjectflow shape
dc.subjectOSA
dc.subjectsite of pharyngeal collapse
dc.subject.otherobstructive sleep-apnea
dc.subject.otherpressure devices
dc.subject.otherendoscopy
dc.subject.othercollapsibility
dc.subject.otherlimitation
dc.subject.otherpatterns
dc.subject.othersurgery
dc.subject.otheradults
dc.subject.othersystem
dc.subject.otherbench
dc.subject.wosCritical Care Medicine
dc.subject.wosRespiratory System
dc.titleAirflow Shape Is Associated With the Pharyngeal Structure Causing OSA
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryAustrália
hcfmusp.affiliation.countryisoau
hcfmusp.affiliation.countryisous
hcfmusp.author.externalSANDS, Scott A.:Harvard Med Sch, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Neurol, Boston, MA USA; Alfred & Monash Univ, Dept Allergy Immunol & Resp Med, Melbourne, Vic, Australia; Alfred & Monash Univ, Cent Clin Sch, Melbourne, Vic, Australia
hcfmusp.author.externalBUTLER, James P.:Harvard Med Sch, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Neurol, Boston, MA USA
hcfmusp.author.externalLORING, Stephen H.:Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Anesthesia, Boston, MA USA
hcfmusp.author.externalKATZ, Eliot S.:Harvard Med Sch, Boston Childrens Hosp, Div Resp Dis, Boston, MA USA
hcfmusp.author.externalDEMKO, B. Gail:Sleep Apnea Dentists New England, Weston, MA USA
hcfmusp.author.externalKEZIRIAN, Eric J.:USC, Keck Sch Med, Dept Otolaryngol Head & Neck Surg, USC Caruso, Los Angeles, CA USA
hcfmusp.author.externalWHITE, David P.:Harvard Med Sch, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Neurol, Boston, MA USA
hcfmusp.author.externalWELLMAN, Andrew:Harvard Med Sch, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Med, Boston, MA USA; Harvard Med Sch, Brigham & Womens Hosp, Div Sleep & Circadian Disorders, Dept Neurol, Boston, MA USA
hcfmusp.citation.scopus82
hcfmusp.contributor.author-fmusphcPEDRO RODRIGUES GENTA
hcfmusp.description.beginpage537
hcfmusp.description.endpage546
hcfmusp.description.issue3
hcfmusp.description.volume152
hcfmusp.origemWOS
hcfmusp.origem.pubmed28651794
hcfmusp.origem.scopus2-s2.0-85029006165
hcfmusp.origem.wosWOS:000409525600023
hcfmusp.publisher.cityAMSTERDAM
hcfmusp.publisher.countryNETHERLANDS
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