Physiologic and anatomic determinants of hyoid motion during drug-induced sleep endoscopy.

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY Sleep and Breathing Pub Date : 2024-10-01 Epub Date: 2024-07-11 DOI:10.1007/s11325-024-03101-5

Manan H Parekh, Eric Thuler, Vasiliki Triantafillou, Everett Seay, Chandra Sehgal, Susan Schultz, Brendan T Keenan, Alan R Schwartz, Raj C Dedhia

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Abstract

Purpose: To examine factors accounting for differences in hyoid motion during obstructive breathing events amongst obstructive sleep apnea (OSA) patients.

Methods: This was a prospective cohort study from June 2022 to October 2022. Patients with OSA undergoing evaluation for PAP alternative therapies with drug-induced sleep endoscopy with positive airway pressure titration (DISE-PAP). All patients underwent DISE-PAP and concurrent hyoid-focused ultrasound. DISE-PAP enabled measurement of airway physiology (flow, respiratory effort) and airway collapsibility (pharyngeal opening pressure, PhOP). Hyoid-ultrasound enabled hyoid bone movement during obstructive breathing. Respiratory effort was measured using a retro-epiglottic pressure-sensitive catheter. Hyoid position was measured using a standardized, awake, CT protocol. Regression analyses adjusted for age, race, sex, and BMI were performed to associate indices of respiratory effort and CT data with hyoid motion.

Results: On average, the 26 patients in this cohort were older (63.9 ± 10.5 years), male (69%), overweight (29.6 ± 3.99 kg/m²), and with moderate-to-severe OSA (26.8 ± 10.4 events/hour). Greater respiratory effort was associated with increased hyoid motion (β [95% CI] = 0.034 [0.016,0.052], standardized β = 0.261,p = 0.0003). Higher hyoid position was associated with greater hyoid displacement (β [95% CI] = -0.20 [-0.38,-0.01], Standardized β = -0.57, p = 0.036).

Conclusion: Our data demonstrate that greater respiratory effort, higher hyoid position, and higher airway collapsibility, but not airflow, are associated with greater hyoid motion during obstructive breathing in DISE. These findings suggest that downward hyoid movement represents a compensatory response to upper airway obstruction. Further studies should investigate the vectors of hyoid motion to better understand its role in sleep-related airway collapse.

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药物诱导睡眠内窥镜检查时舌骨运动的生理和解剖决定因素。

目的：研究阻塞性睡眠呼吸暂停（OSA）患者在阻塞性呼吸事件中导致舌骨运动差异的因素：这是一项前瞻性队列研究，研究时间为 2022 年 6 月至 2022 年 10 月。接受药物诱导睡眠内窥镜检查和气道正压滴定（DISE-PAP）评估的 OSA 患者接受 PAP 替代疗法。所有患者均接受了 DISE-PAP 和舌骨聚焦超声检查。DISE-PAP 可测量气道生理学（流量、呼吸强度）和气道塌陷度（咽部开口压，PhOP）。在阻塞性呼吸过程中，舌骨超声波可实现舌骨运动。使用会厌后压敏导管测量呼吸强度。舌骨位置采用标准化的清醒 CT 方案进行测量。根据年龄、种族、性别和体重指数进行回归分析，将呼吸强度指数和 CT 数据与舌骨运动联系起来：26名患者平均年龄（63.9 ± 10.5 岁）、男性（69%）、超重（29.6 ± 3.99 kg/m2）、中重度 OSA（26.8 ± 10.4 次/小时）。更大的呼吸强度与舌骨运动增加有关（β [95% CI] = 0.034 [0.016,0.052], 标准化 β = 0.261,p = 0.0003）。舌骨位置越高，舌骨位移越大（β [95% CI] = -0.20 [-0.38,-0.01], 标准化 β = -0.57, p = 0.036）：我们的数据表明，在阻塞性呼吸过程中，DISE患者更大的呼吸强度、更高的舌骨位置和更高的气道塌陷度（而非气流）与更大的舌骨运动相关。这些发现表明，舌骨向下运动是对上气道阻塞的一种代偿反应。进一步的研究应调查舌骨运动的矢量，以更好地了解其在与睡眠相关的气道塌陷中的作用。

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.