Influence of upper airways section area on oxygen blood saturation level in patients with obesity and sleep apnea syndrome Poster No.: P-0028 Congress: ESCR 2015 Type: Scientific Poster Authors: E. Butorova, D. Ustyuzhanin, M. Shariya, A. litvin; Moscow/RU Keywords: Head and neck, Respiratory system, MR, Comparative studies, Obstruction / Occlusion, Metabolic disorders Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.escr.org Page 1 of 11
Purpose Obstructive sleep apnea syndrome (OSAS) is the most common form of the breathing violation during sleep. The syndrome often remains undiagnosed. This condition is characterized by the presence of snoring, repetitive partial or complete cessation of breathing during sleep, long enough to reduce the level of oxygen in the blood, rough sleep fragmentation and excessive daytime sleepiness. The prevalence of OSAS is 5-7% of the population older than 30 years. Severe forms of the disease affect approximately 1-2% of the specified group of persons. Currently OSAS is regarded as an independent risk factor for various cardiovascular diseases. The most common criterion of apnea severity is the sleep apnea-hypopnea index, but there are some other parameters also indicating the severity (e.g. the level of oxygen saturation SaO2). The aim of the study was to compare the upper airway section area in patients with obesity and sleep apnea syndrome who have oxygen blood saturation (SpO2) level less and more than 75%. Methods and Materials 40 male patients with obesity (body-mass index was more than 30 kg/m2) and complaints of snoring were enrolled in the study. All patients underwent polysomnography, cardiorespiratory monitoring examinations and MRI (Phillips Achieva 3.0 T scanner with 16-channel head coil was used). Patients had apnea-hypopnea index (AHI) of 52±17. 20 patients with minimal SpO2<75% formed the first group. 20 patients with minimal SpO2>75% were included in the second group. Area of maximum airway constriction (SmaxCA) at the level of retropalatal region, volume of the soft palate (VSP), volume of the lateral walls (VLW) at the retropalatal region were calculated for 2 groups. Results Our study showed area of maximum airway constriction (SmaxCA) at the level of retropalatal region of 0.5±0.2 cm2 and 0.7±0.2 cm2 for the first and the second groups, respectively, p<0.05. Volume of the lateral walls was larger in patients with SpO2<75% (12.1±1.8 cm3 vs. 11.2±3.2 cm3) comparing with the second group, p<0.05. volume of the soft palate was comparable in two groups (9.1±1.5 cm3 vs. 7.9±2.5 cm3), p=0.1. Page 2 of 11
Fig. 1: Midsagittal magnetic resonance image (MRI), T1-weighted imaging, obese patient with severe degree of OSA: a - patient with SpO2>75%. 1 - soft palate, 2 tongue. References: Dept. of Tomography, Cardiology Research Center - Moscow/RU Page 3 of 11
Fig. 2: Midsagittal magnetic resonance image (MRI), T1-weighted imaging, obese patient with severe degree of OSA: b - patient with SpO2<75%. 1 - soft palate, 2 tongue. References: Dept. of Tomography, Cardiology Research Center - Moscow/RU Page 4 of 11
Fig. 3: Axial magnetic resonance image (MRI), T1-weighted imaging, obese patient with severe degree of OSA: a - patient with SpO2>75%. 1- soft palate, 2 - tongue, 3 lateral walls, 4 - area of maximum airway constriction at the level of retropalatal region. References: Dept. of Tomography, Cardiology Research Center - Moscow/RU Page 5 of 11
Fig. 4: Axial magnetic resonance image (MRI), T1-weighted imaging, obese patient with severe degree of OSA: b - patient with SpO2<75%. 1- soft palate, 2 - tongue, 3 lateral walls, 4 - area of maximum airway constriction at the level of retropalatal region. References: Dept. of Tomography, Cardiology Research Center - Moscow/RU In our study MR images of patients with different levels of oxygen saturation during sleep were examined. The results of the study showed that patients with obesity and severe OSAS with a level of minspo2 <75% had less area of maximum airway constriction due to the increase in the volume of the lateral walls. These changes determines the clinical course of OSAS. Patients pay attention to the progression of daytime sleepiness, fatigue, poor concentration, headaches, irritability, and others. MRI is good technique to assess the anatomy of the upper respiratory tract. MRI can determine the level of obstruction and also can assess anatomical structures around the upper airways that caused the obstruction. Page 6 of 11
Images for this section: Fig. 1: Midsagittal magnetic resonance image (MRI), T1-weighted imaging, obese patient with severe degree of OSA: a - patient with SpO2>75%. 1 - soft palate, 2 - tongue. Page 7 of 11
Fig. 2: Midsagittal magnetic resonance image (MRI), T1-weighted imaging, obese patient with severe degree of OSA: b - patient with SpO2<75%. 1 - soft palate, 2 - tongue. Page 8 of 11
Fig. 3: Axial magnetic resonance image (MRI), T1-weighted imaging, obese patient with severe degree of OSA: a - patient with SpO2>75%. 1- soft palate, 2 - tongue, 3 - lateral walls, 4 - area of maximum airway constriction at the level of retropalatal region. Page 9 of 11
Fig. 4: Axial magnetic resonance image (MRI), T1-weighted imaging, obese patient with severe degree of OSA: b - patient with SpO2<75%. 1- soft palate, 2 - tongue, 3 - lateral walls, 4 - area of maximum airway constriction at the level of retropalatal region. Page 10 of 11
Conclusion Patients with obesity, severe sleep apnea syndrome and oxygen blood saturation level less than 75% showed significantly smaller the upper airway section area and larger the volume of the lateral walls at the retropalatal region. References 1. Chi L, Comyn FL, Mitra N, et al. Identification of craniofacial risk factors for obstructive sleep apnoea using three-dimensional MRI. Eur Respir J 2011; 38:348-58. 2. Sutherland K., Richard J. Schwab et al. Facial Phenotyping by Quantitative Photography Reflects Craniofacial Morphology Measured on Magnetic Resonance Imaging in Icelandic Sleep Apnea Patients. Sleep 2014; 37(5):959-968. 3. Amra B, Peimanfar A, Abdi E et al. Relationship between craniofacial photographic analysis and severity of obstructive sleep apnea/hypopnea syndrome in Iranian patients. J Res Med Sci. 2015; 20(1): 62-5. 4. Kim YC, Hayes CE, Narayanan SS, Nayak KS. Novel 16-channel receive coil array for accelerated upper airway MRI at 3 Tesla. Magn Reson Med. 2011; 65(6):1711-7. 5. Kim AM, Keenan BT, Nicholas Jackson N et al. Tongue fat and its relationship to obstructive sleep apnea. Sleep 2014; 37(10):1639-1648. Page 11 of 11