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Am. J. Respir. Crit. Care Med., Volume 157, Number 2, February 1998, 586-593

Histological Indications of a Progressive Snorers Disease in an Upper Airway Muscle

DANIELLE FRIBERG, TOR ANSVED, KRISTIAN BORG, BRITT CARLSSON-NORDLANDER, HÅKAN LARSSON, and EVA SVANBORG

Department of Otorhinolaryngology, Söder Hospital, Karolinska Institute, and Departments of Neurology and Neurophysiology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden

The etiology of upper airway collapsibility in patients with snoring and obstructive sleep apnea (OSA) remains unclear. Local muscular abnormalities, including neurogenic lesions, could be a contributory factor. The aim of this study was to histologically evaluate the hypothesis of a progressive snorers disease. Biopsies of palatopharyngeal muscle were obtained from 21 patients with habitual snoring and different degrees of upper airway obstruction (10 patients with OSA) and 10 nonsnoring control subjects. Morphological abnormalities, including neurogenic signs (e.g., type grouping), were blindly quantified. The degree of abnormality was significantly increased in patients compared with control subjects. The individual score of abnormalities was significantly correlated to the percentage periodic obstructive breathing but not to oxygen desaturation index. Analyses of the individual fiber-size spectra demonstrated a significantly increased number of hypertrophied and/or atrophied fibers in patients compared with controls. The subjects were also divided into three groups according to their type of nocturnal breathing, i.e., nonsnorers, patients with < 20%, and patients with >=  45% obstructive breathing. These groups correlated significantly with the degree of abnormality and pathological fiber-size spectra. In conclusion, these results support the hypothesis of a progressive local neurogenic lesion, caused by the trauma of snoring, as a possible contributory factor to upper airway collapsibility.




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