Compensatory head posture changes in patients with obstructive sleep apnea

Abstract

The upper airway narrowing and changes in head posture and their relationship with apnea severity in patients with obstructive sleep apnea (OSA) were investigated. In 86 male OSA patients and 37 healthy men, one-night polysomnographic examination was performed and a lateral cephalogram by digital image processing system was taken in each subject. Fifteen variables concerning the upper airway dimensions, area and head postures were measured by using a computer software (NIH Image). The results showed that upper airway dimensions in the OSA group at all levels were significantly smaller than those in the control group and the results hold true when the age and body mass index were well controlled in these two groups. Significant forward inclination of the cervical column was found in the patients with an apnea index (AI) greater than 35 episodes/h. And changes in the head posture variables in the whole study group were significantly correlated with AI and airway dimensions at various levels. It was suggested that there exist significant and extensive upper airway narrowing in OSA patients even in upright position and awake state; And as the apnea severity progresses, patients may assume certain compensatory head postures in an attempt to maintain an adequate airway patency.

Keywords

sleep apnea / obstructive / cephalometry / pathogenesis

References

[1] YoungT, PaltaM, DempesyJ, et al.. The occurrence of sleep disordered breathing among middle aged adults. N Engl J Med, 1993, 328: 1230-1230

[2] DaviesR J O, StradlingJ R. The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnea syndrome. Eur Respir J, 1990, 3: 509-509

[3] SolowB, SkovS, OvesenJ, et al.. Airway dimensions and head posture in obstructive sleep apnea. Eur J Orthod, 1996, 18: 571-571

[4] SakakibaraH, TongM, MatsushitaK, et al.. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnea. Eur Respir J, 1999, 13: 403-403

[5] TongM. Cephalometric analysis in patients with sleep disordered breathing: implications in the pathogenesis and management. Bull Fujita Med Soc, 1998, 17: 639-639

[6] FergusonK A, OnoT, LoweA A, et al.. The relationship between obesity and craniofacial structure in obstructive sleep apnea. Chest, 1995, 108: 375-375

[7] NelsonS, HansM. Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest, 1997, 111: 154-154

[8] SolowB, OvesenJ, NielsenP W, et al.. Head posture in obstructive sleep apnea. Eur J Orthod, 1993, 15: 107-107

[9] TangugsornV, SkatvedtO, KrogstadO, et al.. Obstructive sleep apnea: a cephalometric study. Part I. Cervico-craniofacial skeletal morphology. Eur J Orthodontics, 1995, 17: 45-45