Analysis of Obstruction Site in Obstructive Sleep Apnea Patients Based on Videofluoroscopy

Hye Rang Choi; Kyujin Han; Jiyeon Lee; Seok-Chan Hong; Jin Kook Kim; Jae Hoon Cho

doi:10.18787/jr.2019.26.1.21

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Choi, Han, Lee, Hong, Kim, and Cho: Analysis of Obstruction Site in Obstructive Sleep Apnea Patients Based on Videofluoroscopy

Original Article

Journal of Rhinology 2019; 26(1): 21-25.

Published online: 31 May 2019

DOI: https://doi.org/10.18787/jr.2019.26.1.21

Analysis of Obstruction Site in Obstructive Sleep Apnea Patients Based on Videofluoroscopy

Hye Rang Choi, MD, Kyujin Han, MD, Jiyeon Lee, MD, Seok-Chan Hong, MD, PhD, Jin Kook Kim, MD, PhD, Jae Hoon Cho, MD, PhD

Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University, Seoul, Korea.

Corresponding author (jaehoon@kuh.ac.kr)

Received 13 February 2018 Revised 25 April 2018 Accepted 8 June 2018

Journal of Rhinology

Abstract

Background and Objectives

Upper airway obstruction can occur at the soft palate, tongue base, or epiglottis among obstructive sleep apnea (OSA) patients. Detection of these obstruction sites is very important for choosing a treatment modality for OSA. The purpose of this study was to evaluate the obstruction site of OSA patients and its association with mouth opening and head position.

Subjects and Method

Forty-eight consecutive patients with suspicion of OSA were enrolled and underwent videofluoroscopy to evaluate the obstruction site, as well as polysomnography. Obstruction site, mouth opening, and head position were evaluated on videofluoroscopy, and their association was analyzed.

Results

According to the videofluoroscopy, 47 (97.9%) of 48 patients showed an obstruction in the soft palate, while 24 (50.0%) were located in the tongue base and 14 (29.2%) in the epiglottis. Multiple obstructions were observed in many patients. Mean apnea-hypopnea index was higher among patients with tongue base obstruction (42.3±26.7) compared to those without obstruction (26.4±21.2, p=0.058). However, epiglottis obstruction did not influence apnea-hypopnea index. Mouth opening did not show any association with tongue base obstruction (p=0.564), while head flexion was highly associated (p<0.001).

Conclusion

Half of patients with OSA have tongue base obstruction, which worsens the apnea-hypopnea index. Head flexion is associated with tongue base obstruction, while mouth opening is not.

Keywords: Obstructive sleep apnea, Tongue base, Videofluoroscopy

Figures and Tables

Fig. 1

A: Angle of head position. It is defined by the intersection of two lines. One connects the midpoint of the pituitary fossa to the nasion and the other line is posteriorly tangent to the cervical vertebra through the second and the fourth. B: Angle of mouth opening. It is formed by the intersection of lines drawn from the maxillary incisor to the glenoid fossa and from the glenoid fossa to the mandibular incisor.

Fig. 2

Distribution of obstruction sites.

Table 1

Association of mouth opening and head flexion with tongue base obstruction

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