Pharyngeal Airway Dimensions and Head Posture in Obstructive Sleep Apnea Patients with and without Morphological Deviations in the Upper Cervical Spine

Liselotte Sonnesen, Arne Petersson, Søren Berg, Palle Svanholt, Liselotte Sonnesen, Arne Petersson, Søren Berg, Palle Svanholt

Abstract

Objectives: The aim of the study was to analyse differences in pharyngeal airway dimensions and head posture between obstructive sleep apnea patients with and without morphological deviations in the upper cervical spine and to analyse associations between pharyngeal airway dimensions and head posture in the total sample.

Material and methods: The sample comprised 53 obstructive sleep apnea (OSA) patients of which 32.1% had upper spine morphological deviations. Accordingly two groups were defined: 17 OSA patients with morphological deviations in the upper spine and 36 without upper spine deviations. Pharyngeal airway dimensions in terms of distances, cross-sectional areas and volume and upper spine morphological deviations were evaluated on cone-beam computed tomography. Head posture was evaluated on two-dimensional generated lateral cephalograms. Differences were analysed and adjusted for age and gender by multiple linear regression analysis.

Results: OSA patients with upper spine morphological deviations had a significantly more backward and curved neck posture (OPT/HOR, P < 0.01; OPT/CVT, P < 0.05) compared to OSA patients without spine deviations. No significant differences were found in airway dimensions between patients with and without upper spine deviations. In the total group significant associations were found between head posture and pharyngeal airway distances and cross-sectional area at the nasal floor, epiglottis and hyoid bone level (P < 0.05, P < 0.01, P < 0.001). No significant association was found between head posture and airway volume.

Conclusions: The results may contribute to differentiate obstructive sleep apnea patients and thereby may prove valuable in diagnosis and treatment planning of obstructive sleep apnea patients.

Keywords: nasopharynx; obstructive sleep apnea; oropharynx; standing position; vertebral column.

Figures

Figure 1
Figure 1
Pharyngeal reference levels illustrated in the mid sagittal view. NF = nasal floor, through the most posterior and inferior point of the cavum nasi; V = velum, the shortest antero-posterior distance behind velum palate; RL = radix linguae, the narrowest point behind radix linguae; EP = epiglottis, the level through the top of epiglottis; HY = hyoid bone, the level where the vocal chord is visible.
Figure 2
Figure 2
Pharyngeal reference points. NF = nasal floor level: most anterior (nfa) and posterior (nfp) point in the sagittal plane, the most right (nfr) and left (nfl) point. V = velum level: the most anterior (vam) and posterior (vmp) point in the sagittal plane, the most anterior (var) and posterior point (vpr) in the right part, the most anterior (val) and posterior point (vpl) in the left part. RL = radix linguae level: most anterior (rla) and posterior point (rlp) in the sagittal plane, the most right (rlr) and left (rll) point. EP = epiglottis level: most anterior (epa) and posterior point (epp) in the sagittal plane, the most right (epr) and left (epl) point. HY = hyoid bone level: most anterior (hya) and posterior (hyp) point in the sagittal plane, the most right (hyr) and left (hyl) point.
Figure 3
Figure 3
Illustration of pharyngeal volumes in the mid sagittal view. A = total pharyngeal volume between nasal floor plane and epiglottis plane; B = oropharyngeal volume between velum plane and epiglottis plane.
Figure 4
Figure 4
Reference points and lines describing the head posture on two-dimensional generated lateral cephalogram [31]. FH = Frankfurter horizontal through or and po; or = orbitale, the most inferior point of foramen orbitale; po = porion, the most inferior point of apertura acusticus. NL = nasal line through sp and pm; sp = spinal point, the apex of in the anterior nasal spine; pm = pterygomaxillare, the intersection between the nasal floor and the posterior contour of the maxilla. OPT = odontoid process tangent through cv2ip and cv2tg; cv2ip = the most posteroinferior point on the corpus of C2; cv2tg = the tangent point on the dorsal contour of the odontoid process of C2 to a line from cv2ip. CVT = cervical vertebra tangent through cv4ip and cv2tg; cv4ip = the most posteroinferior point on the corpus of C4. VER = true vertical line; HOR = true horizontal line. Postural angles are indicated in black.

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