Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea.
OBJECTIVE
To identify abnormalities in airway size and shape that correlate with the presence and severity of obstructive sleep apnea (OSA).


METHODS
This was a retrospective case series of patients undergoing treatment of OSA who had preoperative computed tomographic (CT) scans of the upper airway available. Patients who had undergone CT scanning for nonairway pathologic features during the same period served as the controls. Digital 3D-CT reconstructions were made and 12 parameters of airway size and 4 of shape were analyzed. The posterior airway space, middle airway space, and hyoid to mandibular plane distance were measured on the lateral cephalograms of the patients with OSA. Bivariate analysis was used to identify the factors associated with the presence and severity of OSA as measured by the respiratory disturbance index (RDI). Multiple regression analysis identified the factors that correlated with the RDI.


RESULTS
Of the 44 patients with OSA, 15 (10 men and 5 women) had pre- and postoperative CT scans available. In addition, 17 patients (11 men and 6 women) were used as controls. The airway length was significantly increased in the patients with OSA (P < .01). On bivariate analysis, the length, lateral/retroglossal anteroposterior dimension ratio and genial tubercle to hyoid bone distance were associated with the RDI (P < .03). On multiple regression analysis, length (P < .01) had a positive correlation and the lateral/retroglossal anteroposterior dimension ratio (P = .04) an inverse correlation with the RDI.


CONCLUSIONS
The results of this study indicate that the presence of OSA is associated with an increase in airway length. Airways that were more elliptical in shape and mediolaterally oriented (greater lateral/retroglossal anteroposterior dimension ratio) had a decreased tendency toward obstruction.
Abramson
Zachary
Z
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA.
Susarla
Srinivas
S
August
Meredith
M
Troulis
Maria
M
Kaban
Leonard
L
D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D002508:Cephalometry; D004825:Epiglottis / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D006928:Hyoid Bone / Q000000981:diagnostic imaging; D021621:Imaging, Three-Dimensional; D008297:Male; D021362:Palate, Hard / Q000000981:diagnostic imaging / Q000473:pathology; D010160:Palate, Soft / Q000000981:diagnostic imaging / Q000473:pathology; D010614:Pharynx / Q000000981:diagnostic imaging* / Q000473:pathology; D011857:Radiographic Image Interpretation, Computer-Assisted; D012044:Regression Analysis; D012137:Respiratory System / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014059:Tongue / Q000000981:diagnostic imaging / Q000473:pathology