The use of sub-mental ultrasonography for identifying patients with severe obstructive sleep apnea

Chin-Chung Shu, Peilin Lee, Jou-Wei Lin, Chun-Ta Huang, Yeun-Chung Chang, Chong-Jen Yu, Hao-Chien Wang, Chin-Chung Shu, Peilin Lee, Jou-Wei Lin, Chun-Ta Huang, Yeun-Chung Chang, Chong-Jen Yu, Hao-Chien Wang

Abstract

Objective: This study aimed to explore the association between obstructive sleep apnea (OSA) severity and pharyngeal parameters using sub-mental ultrasonography (US), and investigate the accuracy of US for identifying severe OSA patients.

Methods: One hundred and five consecutive referrals for suspected OSA were enrolled. The diameters of the retro-glossal (RG) and retro-palatal (RP) regions were measured via sub-mental US upon expiration during tidal breathing, forced inspiration, and Müller maneuver (MM). Independent factors associated with severe OSA identified from two-thirds of randomly-selected patients (model-development group) were used to construct a model for predicting severe OSA. The accuracy of the model was validated in the remaining one-third of patients (validation group).

Results: Fifty severe OSA patients, 30 with mild-moderate OSA, and 25 without OSA were enrolled. Compared to non-OSA and mild-moderate OSA patients, those with severe OSA had narrower RP diameter in all three maneuvers. Using the prediction model constructed with changes of RP diameters at MM and neck circumference, the independent predictors of severe OSA in the model-development group had 100% sensitivity and 65% specificity.

Conclusion: Sub-mental US can accurately discriminate the severity of OSA and be used to identify patients with severe OSA.

Trial registration: ClinicalTrials.gov NCT00674076.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Protocol for sub-mental scanning.
Figure 1. Protocol for sub-mental scanning.
The procedure on ultrasound scanning is shown on the left panel and the corresponding computed tomography and ultrasonographic images on the right panel. A, Geniohyoid muscle; B, ramus of the mandible; C, hypoglossal muscle and corresponding acoustic shadow; D, airspace; H, hyoid bone and its acoustic shadow; T, tongue; HM, hyoid-external-meatus; RG, retro-glossal; RP, retro-palatal; UAL, upper airway length.
Figure 2. Flowchart of the trial.
Figure 2. Flowchart of the trial.
Figure 3. Receiver operating characteristic (ROC) curves…
Figure 3. Receiver operating characteristic (ROC) curves for probability of severe OSA in the (A) model-development group and (B) validation group.

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