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Published ahead of print on May 13, 2003, doi:10.1164/rccm.200208-866OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 5, September 2003, 522-530

A more recent version of this article appeared on September 1, 2003
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Submitted on August 15, 2002
Accepted on May 9, 2003

Identification of Upper Airway Anatomic Risk Factors for Obstructive Sleep Apnea with Volumetric MRI

Richard J Schwab1*, Michael Pasirstein2, Robert Pierson2, Adonna Mackley2, Robert Hachadoorian2, Raanan Arens2, Greg Maislin3, and Allan I Pack1

1 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA; Pulmonary, Allergy and Critical Care Division, University of Pennsylvania Medical Center, Philadelphia, PA, USA; Division of Sleep Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA, 2 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA, 3 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA; Division of Sleep Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA

* To whom correspondence should be addressed. E-mail: rschwab{at}mail.med.upenn.edu.

We utilized sophisticated volumetric analysis techniques with magnetic resonance imaging in a case-control design to study the upper airway soft tissue structures in 48 controls (apnea hypopnea index: 2.0±1.6 events/hour) and 48 patients with sleep apnea (apnea hypopnea index: 43.8±25.4 events/hour). Our design utilized exact matching on gender and ethnicity, frequency matching on age, and statistical control for craniofacial size and visceral neck fat. The data support our a priori hypotheses that the volume of the soft tissue structures surrounding the upper airway was enlarged in patients with sleep apnea and that this enlargement was a significant risk factor for sleep apnea. After covariate adjustments the volume of the lateral pharyngeal walls (p<0.0001), tongue (p<0.0001), and total soft tissue (p<0.0001) were significantly larger in apneics than normals. These data also demonstrated significantly increased risk of sleep apnea after covariate adjustments the larger the volume of the tongue, lateral pharyngeal walls and total soft tissue: 1) lateral pharyngeal wall (OR=6.01, 95%CI=2.62-17.14); 2) tongue (OR=4.66, 95%CI=2.31-10.95); and 3) total soft tissue (OR=6.95, 95%CI=3.08-19.11). In a multivariable logistic regression analysis the volume of the tongue and lateral walls were shown to independently increase the risk of sleep apnea.
Key words: magnetic resonance imaging, upper airway, parapharyngeal fat pads, obesity, lateral pharyngeal walls, tongue, soft palate, obstructive sleep apnea, volumetric imaging




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