Effect of sleep on upper airway dynamics in obese adolescents with obstructive sleep apnea syndrome

• Published in: Sleep (New York, N.Y.) N.Y.), 2020-10, Vol.43 (10), p.1
• Main Authors: Bitners, Anna C, Sin, Sanghun, Agrawal, Sabhyata, Lee, Seonjoo, Udupa, Jayaram K, Tong, Yubing, Wootton, David M, Choy, Kok Ren, Wagshul, Mark E, Arens, Raanan
• Format: Article
• Language: English
• Subjects: Adolescent; Biomechanics; Child; Humans; Magnetic resonance imaging; Obesity - complications; Obesity - diagnostic imaging; Obesity in adolescence; Obesity in children; Polysomnography; Sleep; Sleep apnea; Sleep apnea syndromes; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - diagnostic imaging; Sleep Disordered Breathing; Teenagers; Wakefulness; Youth
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsaa071

Abstract Study Objectives The biomechanical basis of obstructive sleep apnea syndrome (OSAS) may influence upper airway dynamics. In this study, we investigate dynamic changes during respiration in wakefulness and sleep in obese adolescents with and without OSAS. Methods Respiratory-gated dynamic magnetic resonance imaging (MRI) at the retropalatal and retroglossal regions was performed with simultaneous measurement of SpO2 and nasal-oral mask airflow and pressure. Airway cross-sectional area (CSA) was determined using AMIRA. Percent change in CSA was calculated from five continuous tidal breaths in states of wakefulness and sleep. Mixed effects models were used to evaluate interactions between group (OSAS/control), site (retropalatal/retroglossal), and stage (wake/sleep). Results We studied 24 children with OSAS (mean age 15.49 ± 2.00 years, mean apnea–hypopnea index [AHI] 16.53 ± 8.72 events/h) and 19 controls (mean age 14.86 ± 1.75 years, mean AHI 2.12 ± 1.69 events/h). Groups were similar in age, sex, height, weight, and BMI Z-score. Participants with OSAS had a 48.17% greater increase in percent change of airway CSA during sleep than controls (p < 0.0001), while there was no difference between groups during wakefulness (p = 0.6589). Additionally, participants with OSAS had a 48.80% increase in percent change of airway CSA during sleep as compared with wakefulness (p < 0.0001), whereas no such relationship was observed in controls (p = 0.5513). Conclusions This study demonstrates significant effects of sleep on upper airway dynamics in obese children with OSAS. Dynamic MRI with physiological data can potentially provide further insight into the biomechanical basis of OSAS and assist in more effective management.