Upper airway epithelial structural changes in obstructive sleep-disordered breathing.
The etiology of upper airway collapsibility in patients with snoring and obstructive sleep apnea (OSA) remains unclear. Structural mucosal changes could be contributory factors. The objective of this study was to determine whether pathologic changes in the epithelium or the epithelial-connective tissue interface are present in patients with snoring and/or OSA by means of scanning electron microscopy and immunohistochemistry. Uvulae were obtained by uvulopalatopharyngoplasty from three patients with habitual snoring and nine patients with mild to severe OSA, as well as by dissection from 43 nonsnoring body donors. Scanning electron microscopy revealed structural changes in the epithelial-connective tissue boundary that significantly differed from age-related changes in the control subjects. The immunohistochemical staining with antibodies against epithelial cytokeratins showed differences in the expression pattern of cytokeratin 13 between patients and control subjects. No differences were found in the distribution pattern of laminin. Analysis of defense cells revealed a significant diffuse infiltration of leukocytes, mainly T cells, inside the lamina propria of the patient group, which was not observed in the control group. In conclusion, these results support the hypothesis that progressive structural changes in the mucosa caused by the trauma of snoring are a possible contributory factor to upper airway collapsibility.
Paulsen
Friedrich P
FP
Institute of Anatomy, Christian Albrecht University of Kiel, Olshausenstrasse 40, D-24098 Kiel, Germany. fpaulsen@anat.uni-kiel.de
Steven
Philipp
P
Tsokos
Michael
M
Jungmann
Karl
K
Müller
Andreas
A
Verse
Thomas
T
Pirsig
Wolfgang
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D001706:Biopsy; D015992:Body Mass Index; D002102:Cadaver; D016022:Case-Control Studies; D002423:Cause of Death; D018450:Disease Progression; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D007958:Leukocyte Count; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D017286:Polysomnography; D020545:Respiratory Mucosa / Q000473:pathology* / Q000503:physiopathology; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D012913:Snoring / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D014609:Uvula / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery
D007633:Keratins