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Neuromuscular Alterations of Upper Airway Muscles in Patients with OSAS: Radiological and Histopathological Findings

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Data Mining for Biomarker Discovery

Part of the book series: Springer Optimization and Its Applications ((SOIA,volume 65))

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Abstract

This article reviews studies of upper airway muscles in humans, observed in patients with obstructive sleep apnea syndrome (OSAS). These studies include neuromuscular abnormalities of the upper airway muscles, along with changes of the upper airway lumen which is narrower in patients with OSAS than normal subjects. Several approaches have been made in the imaging of the upper airway using X-ray, CT, and MRI in order to characterize the severity of OSAS. Up to date results on histopathology of the muscles across with nervous lesions, are also reviewed.

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References

  1. M.B. Abbott, L.F. Donnelly, B.J. Dardzinski, S.A. Poe, B.A. Chini, and R.S. Amin. Obstructive sleep apnea: Mr imaging volume segmentation analysis1. Radiology, 232(3):889, 2004.

    Google Scholar 

  2. R. Arens, J.M. McDonough, A.M. Corbin, N.K. Rubin, M.E. Carroll, A.I. Pack, J. Liu, and J.K. Udupa. Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. American journal of respiratory and critical care medicine, 167(1):65, 2003.

    Google Scholar 

  3. R. Arens, J.M. McDonough, A.T. Costarino, S. Mahboubi, C.E. Tayag-Kier, G. Maislin, R.J. Schwab, and A.I. Pack. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. American journal of respiratory and critical care medicine, 164(4):698, 2001.

    Google Scholar 

  4. R. Arens, S. Sin, J.M. McDonough, J.M. Palmer, T. Dominguez, H. Meyer, D.M. Wootton, and A.I. Pack. Changes in upper airway size during tidal breathing in children with obstructive sleep apnea syndrome. American journal of respiratory and critical care medicine, 171(11):1298, 2005.

    Google Scholar 

  5. E. Avrahami, A. Solomonovich, and M. Englender. Axial ct measurements of the cross-sectional area of the oropharynx in adults with obstructive sleep apnea syndrome. American journal of neuroradiology, 17(6):1107, 1996.

    Google Scholar 

  6. G.C. Barkdull, C.A. Kohl, M. Patel, and T.M. Davidson. Computed tomography imaging of patients with obstructive sleep apnea. The Laryngoscope, 118(8):1486–1492, 2008.

    Article  Google Scholar 

  7. J.M. Battagel, A. Johal, and B. Kotecha. A cephalometric comparison of subjects with snoring and obstructive sleep apnoea. The European Journal of Orthodontics, 22(4):353, 2000.

    Google Scholar 

  8. JM Battagel and PR L’Estrange. The cephalometric morphology of patients with obstructive sleep apnoea (osa). The European Journal of Orthodontics, 18(1):557, 1996.

    Google Scholar 

  9. T.D. Bradley and J.S. Floras. Obstructive sleep apnoea and its cardiovascular consequences. The Lancet, 373(9657):82–93, 2009.

    Article  Google Scholar 

  10. M. Carrera, F. Barbe, J. Sauleda, M. Tomas, C. Gomez, and A.G.N. Agusti. Patients with obstructive sleep apnea exhibit genioglossus dysfunction that is normalized after treatment with continuous positive airway pressure. American journal of respiratory and critical care medicine, 159(6):1960, 1999.

    Google Scholar 

  11. M. Carrera, F. Barbe, J. Sauleda, M. Tomas, C. Gomez, C. Santos, and AGN Agustí. Effects of obesity upon genioglossus structure and function in obstructive sleep apnoea. European Respiratory Journal, 23(3):425, 2004.

    Google Scholar 

  12. N.H. Chen, K.K. Li, S.Y. Li, C.R. Wong, M.L. Chuang, C.C. Hwang, and Y.K. Wu. Airway assessment by volumetric computed tomography in snorers and subjects with obstructive sleep apnea in a far-east asian population (in Chinese). The Laryngoscope, 112(4):721–726, 2002.

    Article  Google Scholar 

  13. L. Chi, M. Thorne-Fitzgerald, T. Gislason, E. Arnardottir, B. Benediktsdottir, H. Einarsdottir, S. Juliusson, A. Pack, and R. Schwab. Gender differences in upper airway size, soft tissue and craniofacial structures in patients with osa. American Journal of Respiratory and Critical Care Medicine, 179 (1 MeetingAbstracts):A5404, 2009.

    Google Scholar 

  14. MA Ciscar, G. Juan, V. Martinez, M. Ramon, T. Lloret, J. Minguez, M. Armengot, J. Marin, and J. Basterra. Magnetic resonance imaging of the pharynx in osa patients and healthy subjects. European Respiratory Journal, 17(1):79, 2001.

    Google Scholar 

  15. R.L. Crumley, M. Stein, J. Golden, G. Gamsu, and S. Dermon. Determination of obstructive site in obstructive sleep apnea. The Laryngoscope, 97(3):301–308, 1987.

    Article  Google Scholar 

  16. K.L. Do, H. Ferreyra, J.F. Healy, and T.M. Davidson. Does tongue size differ between patients with and without sleep-disordered breathing? The Laryngoscope, 110(9):1552–1555, 2000.

    Article  Google Scholar 

  17. L.F. Donnelly, K.A. Casper, B. Chen, and B.L. Koch. Defining normal upper airway motion in asymptomatic children during sleep by means of cine mr techniques1. Radiology, 223(1):176, 2002.

    Google Scholar 

  18. L.F. Donnelly, V. Surdulescu, B.A. Chini, K.A. Casper, S.A. Poe, and R.S. Amin. Upper airway motion depicted at cine mr imaging performed during sleep: Comparison between young patients with and those without obstructive sleep apnea1. Radiology, 227(1):239, 2003.

    Google Scholar 

  19. L. Edström, H. Larsson, and L. Larsson. Neurogenic effects on the palatopharyngeal muscle in patients with obstructive sleep apnoea: a muscle biopsy study. Journal of Neurology, Neurosurgery & Psychiatry, 55(10):916, 1992.

    Google Scholar 

  20. S. Endo, S. Mataki, N. Kurosaki, et al. Cephalometric evaluation of craniofacial and upper airway structures in japanese patients with obstructive sleep apnea. Journal of medical and dental sciences, 50(1):109–120, 2003.

    Google Scholar 

  21. I. Fajdiga. Snoring imaging*. Chest, 128(2):896, 2005.

    Google Scholar 

  22. LJ Ferini-Strambi, S. Smirne, U. Moz, B. Sferrazza, and S. Iannaccone. Muscle fibre type and obstructive sleep apnea. Sleep research online: SRO, 1(1):24, 1998.

    Google Scholar 

  23. R. Foltán, J. Hoffmannová, F. Donev, M. Vlk, K. Šonka, and M. Pretl. Advancement musculus genioglossus and hyoid myotomy in therapy for obstructive sleep apnea syndrome. Ces Slov Neurol Neurochir, 69:57–63, 2006.

    Google Scholar 

  24. R. Foltán, J. Hoffmannová, M. Pretl, F. Donev, and M. Vlk. Genioglossus advancement and hyoid myotomy in treating obstructive sleep apnoea syndrome-a follow-up study. Journal of Cranio-Maxillofacial Surgery, 35(4–5):246–251, 2007.

    Article  Google Scholar 

  25. D. Friberg. Heavy snorer’s disease: A progressive local neuropathy. Journal of the Peripheral Nervous System, 5(2):118–118, 2000.

    Article  Google Scholar 

  26. D. Friberg, T. Ansved, K. Borg, B. Carlsson-Nordlander, H. Larsson, and E. Svanborg. Histological indications of a progressive snorers disease in an upper airway muscle. American journal of respiratory and critical care medicine, 157(2):586, 1998.

    Google Scholar 

  27. A.C. Fry. The role of resistance exercise intensity on muscle fibre adaptations. Sports medicine, 34(10):663–679, 2004.

    Article  MathSciNet  Google Scholar 

  28. R.H.B. Goodday, D.S. Precious, A.D. Morrison, and C.G. Robertson. Obstructive sleep apnea syndrome: diagnosis and management. Journal-Canadian Dental Association, 67(11):652–658, 2001.

    Google Scholar 

  29. C. Guilleminault, K. Li, N.H. Chen, and D. Poyares. Two-point palatal discrimination in patients with upper airway resistance syndrome, obstructive sleep apnea syndrome, and normal control subjects*. Chest, 122(3):866, 2002.

    Google Scholar 

  30. L. Hagander, R. Harlid, and E Svanborg. Sensory nerve lesions in the oropharynx in obstructive sleep apnea. J. Sleep Res, 13 (Suppl 1):299, 2004.

    Google Scholar 

  31. L. Hagander, R. Harlid, and E. Svanborg. Quantitative sensory testing in the oropharynx. Chest, 136(2):481, 2009.

    Google Scholar 

  32. A. Hoekema, B. Hovinga, B. Stegenga, and LGM De Bont. Craniofacial morphology and obstructive sleep apnoea: a cephalometric analysis. Journal of oral rehabilitation, 30(7):690–696, 2003.

    Google Scholar 

  33. F. Hora, L.M. Nápolis, C. Daltro, S.K. Kodaira, S. Tufik, S.M. Togeiro, and L.E. Nery. Clinical, anthropometric and upper airway anatomic characteristics of obese patients with obstructive sleep apnea syndrome. Respiration, 74(5):517–524, 2007.

    Article  Google Scholar 

  34. R.L. Horner. Motor control of the pharyngeal musculature and implications for the pathogenesis of obstructive sleep apnea. Sleep, 19:827–853, 1996.

    Google Scholar 

  35. R.L. Horner, J.A. Innes, H.B. Holden, and A. Guz. Afferent pathway (s) for pharyngeal dilator reflex to negative pressure in man: a study using upper airway anaesthesia. The Journal of physiology, 436(1):31, 1991.

    Google Scholar 

  36. P.P. Hsu, B.Y.B. Tan, Y.H. Chan, H.N. Tay, P.K.S. Lu, and R.L. Blair. Clinical predictors in obstructive sleep apnea patients with computer-assisted quantitative videoendoscopic upper airway analysis. The Laryngoscope, 114(5):791–799, 2004.

    Article  Google Scholar 

  37. DSC Hui, FWS Ko, ASY Chu, JPC Fok, MCH Chan, TST Li, D.K.L. CHOY, CKW Lai, A. Ahuja, and ASC Ching. Cephalometric assessment of craniofacial morphology in chinese patients with obstructive sleep apnoea. Respiratory medicine, 97(6):640–646, 2003.

    Google Scholar 

  38. K. Ikeda, M. Ogura, T. Oshima, H. Suzuki, S. Higano, S. Takahashi, H. Kurosawa, W. Hida, H. Matsuoka, and T. Takasaka. Quantitative assessment of the pharyngeal airway by dynamic magnetic resonance imaging in obstructive sleep apnea syndrome. The Annals of otology, rhinology, and laryngology, 110(2):183, 2001.

    Google Scholar 

  39. A. Johal and C. Conaghan. Maxillary morphology in obstructive sleep apnea: a cephalometric and model study. The Angle Orthodontist, 74(5):648, 2004.

    Google Scholar 

  40. R.J. Kimoff, E. Sforza, V. Champagne, L. Ofiara, and D. Gendron. Upper airway sensation in snoring and obstructive sleep apnea. American journal of respiratory and critical care medicine, 164(2):250, 2001.

    Google Scholar 

  41. H. Larsson, B. Carlsson-Nordlander, LE Lindblad, O. Norbeck, and E. Svanborg. Temperature thresholds in the oropharynx of patients with obstructive sleep apnea syndrome. The American review of respiratory disease, 146(5 Pt 1):1246, 1992.

    Google Scholar 

  42. J.E. Levring, KA Franklin, and A. Isberg. Snoring, sleep apnoea and swallowing dysfunction: a videoradiographic study. Dento maxillo facial radiology, 32(5):311, 2003.

    Google Scholar 

  43. H.Y. Li, N.H. Chen, C.R. Wang, Y.H. Shu, and P.C. Wang. Use of 3-dimensional computed tomography scan to evaluate upper airway patency for patients undergoing sleep-disordered breathing surgery. Otolaryngology–Head and Neck Surgery, 129(4):336, 2003.

    Google Scholar 

  44. H.Y. Li, K.K. Li, N.H. Chen, C.J. Wang, Y.F. Liao, and P.C. Wang. Three-dimensional computed tomography and polysomnography findings after extended uvulopalatal flap surgery for obstructive sleep apnea. American journal of otolaryngology, 26(1):7–11, 2005.

    Article  MATH  Google Scholar 

  45. Y.F. Liao, M.L. Chuang, C.S. Huang, and Y.Y. Tsai. Upper airway and its surrounding structures in obese and nonobese patients with sleep-disordered breathing. The Laryngoscope, 114(6):1052–1059, 2004.

    Article  Google Scholar 

  46. R. Lindman and P.S. Stål. Abnormal palatopharyngeal muscle morphology in sleep-disordered breathing. Journal of the neurological sciences, 195(1):11–23, 2002.

    Article  Google Scholar 

  47. D. Lohnes, M. Mark, C. Mendelsohn, P. Dolle, A. Dierich, P. Gorry, A. Gansmuller, and P. Chambon. Function of the retinoic acid receptors (rars) during development (i). craniofacial and skeletal abnormalities in rar double mutants. Development, 120(10):2723, 1994.

    Google Scholar 

  48. A.A. Lowe, J.A. Fleetham, S. Adachi, and C.F. Ryan. Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. American Journal of Orthodontics and Dentofacial Orthopedics, 107(6):589–595, 1995.

    Article  Google Scholar 

  49. J.M. Marin, S.J. Carrizo, E. Vicente, and A.G.N. Agusti. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. The Lancet, 365(9464):1046–1053, 2005.

    Google Scholar 

  50. I.L. Mortimore and N.J. Douglas. Palatal muscle emg response to negative pressure in awake sleep apneic and control subjects. American journal of respiratory and critical care medicine, 156(3):867, 1997.

    Google Scholar 

  51. IL Mortimore, R. Mathur, and NJ Douglas. Effect of posture, route of respiration, and negative pressure on palatal muscle activity in humans. Journal of Applied Physiology, 79(2):448, 1995.

    Google Scholar 

  52. A.T. Nguyen, V. Jobin, R. Payne, J. Beauregard, N. Naor, and R.J. Kimoff. Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea. Sleep, 28(5):585–593, 2005.

    Google Scholar 

  53. E. Onal, D.L. Burrows, R.H. Hart, and M. Lopata. Induction of periodic breathing during sleep causes upper airway obstruction in humans. Journal of Applied Physiology, 61(4):1438, 1986.

    Google Scholar 

  54. E. Onal and M. Lopata. Periodic breathing and the pathogenesis of occlusive sleep apneas. The American review of respiratory disease, 126(4):676, 1982.

    Google Scholar 

  55. A.I. Pack. Obstructive sleep apnoea. Internal Medicine, 39:517–567, 1994.

    Google Scholar 

  56. D. Pareyson, L. Morandi, V. Scaioli, R. Marazzi, A. Boiardi, and A. Sghirlanzoni. Neurogenic muscle hypertrophy. Journal of neurology, 236(5):292–295, 1989.

    Article  Google Scholar 

  57. SF Quan, JC Gillin, MR Littner, and JW Shepard. Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. editorials. Sleep, 22(5):662–689, 1999.

    Google Scholar 

  58. A. Rachmiel, D. Aizenbud, G. Pillar, S. Srouji, and M. Peled. Bilateral mandibular distraction for patients with compromised airway analyzed by three-dimensional ct. International journal of oral and maxillofacial surgery, 34(1):9–18, 2005.

    Article  Google Scholar 

  59. JE Remmers, WJ DeGroot, EK Sauerland, and AM Anch. Pathogenesis of upper airway occlusion during sleep. Journal of applied physiology: respiratory, environmental and exercise physiology, 44(6):931, 1978.

    Google Scholar 

  60. CF Ryan, AA Lowe, D. Li, and JA Fleetham. Three-dimensional upper airway computed tomography in obstructive sleep apnea. a prospective study in patients treated by uvulopalatopharyngoplasty. The American review of respiratory disease, 144(2):428, 1991.

    Google Scholar 

  61. RJ Schwab, WB Gefter, EA Hoffman, KB Gupta, and AI Pack. Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing. The American review of respiratory disease, 148(5):1385, 1993.

    Google Scholar 

  62. R.J. Schwab, M. Pasirstein, R. Pierson, A. Mackley, R. Hachadoorian, R. Arens, G. Maislin, and A.I. Pack. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric MRI. American journal of respiratory and critical care medicine, 168:522–530, 2003.

    Article  Google Scholar 

  63. A.R. Schwartz, S.P. Patil, A.M. Laffan, V. Polotsky, H. Schneider, and P.L. Smith. Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. In Proceedings of the American Thoraic Society, volume 5, p. 185. Am Thoracic Soc, 2008.

    Google Scholar 

  64. FJ Series, SA Simoneau, S. St Pierre, and I. Marc. Characteristics of the genioglossus and musculus uvulae in sleep apnea hypopnea syndrome and in snorers. American journal of respiratory and critical care medicine, 153(6):1870, 1996.

    Google Scholar 

  65. E. Sforza, W. Bacon, T. Weiss, A. Thibault, C. Petiau, and J. Krieger. Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. American journal of respiratory and critical care medicine, 161(2):347, 2000.

    Google Scholar 

  66. A.S.M. Shamsuzzaman, B.J. Gersh, and V.K. Somers. Obstructive sleep apnea. JAMA: the journal of the American Medical Association, 290(14):1906, 2003.

    Google Scholar 

  67. S. Smirne, S. Iannaccone, L. Ferini-Strambi, M. Comola, R. Nemni, and E. Colombo. Muscle fibre type and habitual snoring. The Lancet, 337(8741):597–599, 1991.

    Article  Google Scholar 

  68. P.E.R.S. Staal and R. Lindman. Characterisation of human soft palate muscles with respect to fibre types, myosins and capillary supply. Journal of Anatomy, 197(02):275–290, 2000.

    Article  Google Scholar 

  69. MG Stein, G. Gamsu, G. De Geer, JA Golden, RL Crumley, and WR Webb. Cine ct in obstructive sleep apnea. American Journal of Roentgenology, 148(6):1069, 1987.

    Google Scholar 

  70. Y. Suto, T. Matsuo, T. Kato, I. Hori, Y. Inoue, S. Ogawa, T. Suzuki, M. Yamada, and Y. Ohta. Evaluation of the pharyngeal airway in patients with sleep apnea: value of ultrafast MR imaging. American Journal of Roentgenology, 160(2):311, 1993.

    Google Scholar 

  71. E. Svanborg. Upper airway nerve lesions in obstructive sleep apnea. American journal of respiratory and critical care medicine, 164(2):187, 2001.

    Google Scholar 

  72. E. van Lunteren, M.A. Haxhiu, and N.S. Cherniack. Effects of tracheal airway occlusion on hyoid muscle length and upper airway volume. Journal of Applied Physiology, 67(6):2296, 1989.

    Google Scholar 

  73. E. Verin, C. Tardif, X. Buffet, JP Marie, Y. Lacoume, J. Andrieu-Guitrancourt, and P. Pasquis. Comparison between anatomy and resistance of upper airway in normal subjects, snorers and osas patients. Respiration physiology, 129(3):335–343, 2002.

    Google Scholar 

  74. W. Vos, J. De Backer, A. Devolder, O. Vanderveken, S. Verhulst, R. Salgado, P. Germonpre, B. Partoens, F. Wuyts, P. Parizel, et al. Correlation between severity of sleep apnea and upper airway morphology based on advanced anatomical and functional imaging. Journal of biomechanics, 40(10):2207–2213, 2007.

    Article  Google Scholar 

  75. K.C. Welch, G.D. Foster, C.T. Ritter, T.A. Wadden, R. Arens, G. Maislin, and R.J. Schwab. A novel volumetric magnetic resonance imaging paradigm to study upper airway anatomy. Sleep, 25(5):532, 2002.

    Google Scholar 

  76. B.T. Woodson, R.J. Toohill, and J.C. Garancis. Histopathologic changes in snoring and obstructive sleep apnea syndrome. The Laryngoscope, 101(12):1318–1322, 1991.

    Article  Google Scholar 

  77. T.B. Woodson and M.R. Wooten. Comparison of upper-airway evaluations during wakefulness and sleep. Laryngoscope, 104:821–828, 1994.

    Google Scholar 

  78. M. Yao, N. Tachibana, M. Okura, T. Tanigawa, K. Yamagishi, A. Ikeda, T. Shimamoto, and H. Iso. Relationships of craniofacial morphology and body mass index with sleep-disordered breathing in japanese men. The Laryngoscope, 114(10):1838–1842, 2004.

    Article  Google Scholar 

  79. K. Yoshida, H. Fukatsu, Y. Ando, T. Ishigaki, and T. Okada. Evaluation of sleep apnea syndrome with low-field magnetic resonance fluoroscopy. European Radiology, 9(6):1197–1202, 1999.

    Article  Google Scholar 

  80. T Young, M Palta, J Dempsey, J Skatrud, S Weber, and S Badr. The occurrence of sdb among middle-aged adults. N Engl J Med, 328:1230–1235, 1993.

    Google Scholar 

  81. X. Yu, K. Fujimoto, K. Urushibata, Y. Matsuzawa, and K. Kubo. Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome*. Chest, 124(1):212, 2003.

    Google Scholar 

  82. A. Yucel, M. Unlu, A. Haktanir, et al. Evaluation of the upper airway cross-sectional area changes in different degrees of severity of obstructive sleep apnea syndrome: cephalometric and dynamic CT study. AJNR Am J Neuroradiol, 26:2624e9, 2005.

    Google Scholar 

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Drakatos, P., Lykouras, D., Sampsonas, F., Karkoulias, K., Spiropoulos, K. (2012). Neuromuscular Alterations of Upper Airway Muscles in Patients with OSAS: Radiological and Histopathological Findings. In: Pardalos, P., Xanthopoulos, P., Zervakis, M. (eds) Data Mining for Biomarker Discovery. Springer Optimization and Its Applications(), vol 65. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-2107-8_12

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