Transverse Maxillary Deficiency Predicts Increased Upper Airway Collapsibility during Drug-Induced Sleep Endoscopy

Eric Thuler; Everett G Seay; John Woo; Jane Lee; Niusha Jafari; Brendan T Keenan; Raj C Dedhia; Alan R Schwartz

doi:10.1002/ohn.258

Transverse Maxillary Deficiency Predicts Increased Upper Airway Collapsibility during Drug-Induced Sleep Endoscopy

Otolaryngol Head Neck Surg. 2023 Aug;169(2):412-421. doi: 10.1002/ohn.258. Epub 2023 Feb 7.

Authors

Eric Thuler¹, Everett G Seay¹, John Woo^{2

3}, Jane Lee², Niusha Jafari⁴, Brendan T Keenan⁴, Raj C Dedhia^{1

4}, Alan R Schwartz^{1

3

5}

Affiliations

¹ Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
² Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
³ Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
⁴ Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
⁵ Department of Otorhinolaryngology, Universidad Peruana Cayetano Heredia School of Medicine, Lima, Peru.

PMID: 36939430
DOI: 10.1002/ohn.258

Abstract

Objective: To examine the relationship between craniofacial skeletal anatomy and objective measures of pharyngeal collapse obtained during drug-induced sleep endoscopy. We hypothesized that transverse maxillary deficiency and an increased pharyngeal length will be associated with higher levels of pharyngeal collapsibility.

Study design: Cross-sectional analysis in a prospective cohort.

Setting: University Hospital.

Methods: A cross-sectional analysis was conducted in a cohort of consecutive patients from the positive airway pressure (PAP) alternatives clinic who underwent computed tomography (CT) analysis and drug-induced sleep endoscopy for characterization of upper airway collapsibility. PAP titration was used to determine pharyngeal critical pressure (P_CRIT ) and pharyngeal opening pressure (PhOP). CT metrics included: Transverse maxillary dimensions (interpremolar and intermolar distances) and pharyngeal length (posterior nasal spine to hyoid distance).

Results: The cohort (n = 103) of severe obstructive sleep apnea (Apnea and Hipopnea Index 32.1 ± 21.3 events/h) was predominantly male (71.8%), Caucasian (81.6%), middle-aged (54.4 ± 14.3 years), and obese (body mass index [BMI] = 30.0 ± 4.9 kg/m² ). Reduced transverse maxillary dimensions were associated with higher P_CRIT (intermolar distance: β [95% confidence interval, CI] = -.25 [-0.14, -0.36] cmH₂ O/mm; p = .03) and PhOP (Interpremolar distance: β = -.25 [-0.14, -0.36] cmH₂ O/mm; p = .02). Longer pharyngeal length was also associated with higher P_CRIT (β = .11 [0.08, 0.14] cmH₂ O/mm, p = .04) and PhOP (β [95% CI] = .06 [0.03, 0.09] cmH₂ O/mm, p = .04). These associations persisted after adjustments for sex, age, height, and BMI.

Conclusion: Our results further the concept that skeletal restriction in the transverse dimension and hyoid descent are associated with elevations in pharyngeal collapsibility during sleep, suggesting a role of transverse deficiency in the pathogenesis of airway obstruction.

Keywords: CT scan; craniofacial analysis; maxillary transverse deficiency; sleep apnea; upper airway collapse.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Aged
Continuous Positive Airway Pressure
Cross-Sectional Studies
Female
Hospitals, University
Humans
Male
Middle Aged
Pharynx* / anatomy & histology
Pharynx* / diagnostic imaging
Prospective Studies
Sleep
Sleep Apnea, Obstructive* / therapy