Predicting OSA Using Radiographs of the Airway Anatomy

Abstract

Mengya Du,1– 3,* Yuqin Gui,3,4,* Yu Guo,1,3,* Jie Liu,1– 3 Wenmin Deng,1– 3 Jingyan Huang,5 Tianrun Liu,1– 3 Xiangmin Zhang,2,5 Feng Pang1– 3 1Department of Otolaryngology, Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Sleep Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510000, People’s Republic of China; 3Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University., Guangzhou, 510000, People’s Republic of China; 4Department of Anesthesiology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China; 5Department of Otolaryngology Head and Neck Surgery, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiangmin Zhang; Feng Pang, Department of Sleep Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuanchun Two Road, Guangzhou, Guangdong, 510065, People’s Republic of China, Tel [phone], Email [email protected]; [email protected]: This study aims to analyze the tongue body shape and upper airway anatomical parameters in patients with Obstructive Sleep Apnea (OSA) and to explore the anatomical causes of OSA.Methods: A total of 345 subjects participated in this study. Lateral pharyngeal images of the upper respiratory tract were captured in both normal and mandibular advancement states using X-ray plain film. Measurements were taken for the following parameters: Tongue Length, Tongue Thickness, Distance from the Mandibular Plane to the Hyoid, Soft Palate Length, Posterior Oropharyngeal Depth, Palatal Airway Space, Tongue Depth Space, and Mental Posterior Space. The correlation between the Apnea-Hypopnea Index (AHI) and these upper airway anatomical factors was analyzed using both univariate and multivariate analyses to develop a predictive model for OSA.Results: The anatomical structure of the upper airway in patients with OSA is narrower compared to non-OSA individuals, and these patients exhibit a longer and thicker tongue. During mandibular advancement, the pharyngeal airway widens; however, the tongue length decreases while its thickness increases. Univariate correlation analysis revealed that the severity of OSA was significantly associated with tongue length, the ratio of tongue length to tongue thickness, the distance from the mandibular plane to the hyoid, soft palate length, and body mass index (BMI) in both the normal position and during mandibular advancement (p < 0.001). Multivariate linear analysis indicated that the severity of OSA is linked with the mandibular plane to hyoid distance in the normal position (MPH(N)) and BMI. A nomogram was utilized to develop a predictive model for OSA, achieving an area under the receiver operating characteristic curve of 0.838.Conclusion: The pathogenesis of OSA is related to pharyngeal anatomy and tongue length in the state of mandibular advancement, which can be predicted by the measurement indexes of normal and anterior mandibular displacement lateral pharyngeal radiograph. This may potentially aid in early screening and diagnosis of OSA.Keywords: obstructive sleep apnea, tongue, pharyngeal radiographs, predicted model, mandibular advancement

Keywords

• obstructive sleep apnea
• tongue
• pharyngeal radiographs
• predicted model
• mandibular advancement