THE ROLE OF DYNAMIC MRI SLEEP STUDIES IN GUIDING THE MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA: AN OBSERVATIONAL ANALYSIS.
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Keywords
Obstructive Sleep Apnea, Dynamic MRI, Apnea-Hypopnea Index, Retropalatal Collapse, Lateral Pharyngeal Wall Collapse
Abstract
Background: Obstructive sleep apnea (OSA) prevalence is increasing due to sedentary lifestyles. Dynamic MRI sleep studies offer detailed anatomical evaluation, identifying the level and pattern of airway obstruction, which can optimize surgical planning. This study investigates the efficacy of dynamic MRI in guiding OSA management.
Methods: This retrospective observational study analyzed dynamic MRI findings in 66 patients previously diagnosed with OSA via polysomnography. The levels and patterns of airway collapse were correlated with apnea-hypopnea index (AHI) severity, and the impact on treatment planning was assessed.
Results: Dynamic MRI revealed significant retropalatal collapse in 62 patients and lateral pharyngeal wall collapse in 53 patients. Retroglossal collapse, often concurrent with retropalatal collapse, was observed in 6 patients. Multilevel collapse (retropalatal, retroglossal, and hypopharyngeal) was present in 3 patients. Based on MRI findings, 48 patients were recommended for surgical intervention. Of the 30 patients who underwent surgery, promising clinical improvement was noted at 6-month follow-up.
Conclusion: Lateral pharyngeal wall collapse was frequently associated with AHI severity. Dynamic MRI provides valuable anatomical information for surgical planning in OSA patients, demonstrating its potential to improve treatment outcomes. Therefore, dynamic MRI is a useful tool in the preoperative assessment of OSA patients.
References
2. Kuna ST, Remmers JE. Neural drive to upper airway muscles during sleep. Am Rev Respir Dis. 1985;132(3):624-629.
3. Huang RC, Young T. Is obesity a major cause of sleep-disordered breathing? Results from the Wisconsin Sleep Cohort Study. J Clin Sleep Med. 2009;5(1):13-17.
4. Franklin KA, Lindberg E. Occurrence of snoring in 50-year-old men. A population-based study. Respir Med. 1995;89(10):681-685.
5. Dong JY, Zhang YH, Tong JL, Qin LQ. The relationship between body mass index and obstructive sleep apnea: a meta-analysis. PLoS One. 2014;9(10):e110355.
6. Schwab RJ, Goldberg AN, Gefter WB, Hoffman EA, Gupta KB, Pack AI. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med. 1995;152(5 Pt 1):1673-1682.
7. Shellock FG, Morisoli SM. MR imaging safety and claustrophobia: survey of patient tolerance. AJR Am J Roentgenol. 1993;161(1):229-231.
8. Han W, Kim DK, Rhee CS, Lee CH, Min YG. Dynamic magnetic resonance imaging of upper airway obstruction in obstructive sleep apnea. Laryngoscope. 2005;115(11):2016-2021.
9. Anwar GM, El-Anwar MW, El-Sawy MM. Role of dynamic MRI in surgical management of obstructive sleep apnea. Eur Arch Otorhinolaryngol. 2013;270(1):217-222.
10. Epstein LJ, Kristo DA, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-276.
11. Chung F, Yegneswaran B, Liao Z, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812-821.
12. Yeom SW, Lee JH, Kim SY, et al. Effect of nasal surgery on quality of life in patients with obstructive sleep apnea. Acta Otolaryngol. 2011;131(1):72-77.
13. Lombardi C, Parati G, Pengo MF, et al. Relationship between systemic hypertension and obstructive sleep apnea syndrome: a cross-sectional study. J Hypertens. 2000;18(12):1703-1709.
14. Altay Z, Altay C, Aksoy N, et al. The relationship between obstructive sleep apnea syndrome and hypertension. Respiration. 2004;71(1):33-37.
15. Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2019;139(19):e53-e68.
16. Alshaer H, Alomari M, Alsheikhmousa J, et al. Snoring and its association with obstructive sleep apnea syndrome. Ann Thorac Med. 2017;12(1):39-44.
17. Volner A, Lavie L, Pillar G. Patterns of upper airway collapse during sleep in obstructive sleep apnea: a meta-analysis. Sleep Med Rev. 2006;10(2):127-135.
18. Kezirian EJ, Powell NB, Riley RW, Li KK, Troell RJ, Guilleminault C. Improvement in continuous positive airway pressure adherence with multilevel surgery in sleep apnea. Otolaryngol Head Neck Surg. 2001;124(4):404-408.
19. Caples SM, Rowley JA, Prinsell JR, et al. Surgical modifications of the upper airway for obstructive sleep apnea. Sleep Med Rev. 2010;14(3):139-154.
20. Kuna ST, Badr MS, Kimoff RJ, et al. Sleep-disordered breathing: a diagnostic algorithm that focuses on the polysomnogram. Proc Am Thorac Soc. 2008;5(2):243-251.
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Dr. Amrita Chowdhury
Assistant Professor, Department of ENT, Gouri Devi Institute of Medical Sciences & Hospital, Durgapur.
Dr. Sabyasachi Chakravarty
Assistant Professor, Department of ENT, Gouri Devi Institute of Medical Sciences & Hospital, Durgapur.
Dr. Manoj Kumar
Assistant Professor, Department of Anatomy, Gouri Devi Institute of Medical Sciences & Hospital, Durgapur