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Title: Magnetic resonance imaging of the upper airway in patients with quadriplegia and obstructive sleep apnea
Austin Authors: O'Donoghue, Fergal J ;Meaklim, Hailey J ;Bilston, Lynne;Hatt, Alice;Connelly, Alan;Jackson, Graeme D ;Farquharson, Shawna ;Sutherland, Kate;Cistulli, Peter A;Brown, Doug ;Berlowitz, David J 
Affiliation: Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
Neuroscience Research Australia, Randwick, NSW, Australia
University of New South Wales, Randwick, NSW, Australia
Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
Spinal Research Institute, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 30-Oct-2017 2017-10-30
Publication information: Journal of sleep research 2018; 27(4): e12616
Abstract: The aim of this study was to investigate upper airway anatomy in quadriplegics with obstructive sleep apnea. Fifty subjects were recruited from three hospitals in Australia: people with quadriplegia due to spinal cord injury and obstructive sleep apnea (n = 11), able-bodied people with obstructive sleep apnea (n = 18), and healthy, able-bodied controls (n = 19). All underwent 3-Tesla magnetic resonance imaging of their upper airway. A subgroup (n = 34) received a topical vasoconstrictor, phenylephrine and post-phenylephrine magnetic resonance imaging. Mixed-model analysis indicated no significant differences in total airway lumen volume between the three groups (P = 0.086). Spinal cord injury-obstructive sleep apnea subjects had a significantly larger volume of soft palate (P = 0.020) and retroglossal lateral pharyngeal walls (P = 0.043) than able-bodied controls. Able-bodied-obstructive sleep apnea subjects had a smaller mandible volume than spinal cord injury-obstructive sleep apnea subjects and able-bodied control subjects (P = 0.036). No differences were seen in airway length between groups when controlling for height (P = 0.055). There was a marginal increase in velopharyngeal volume across groups post-phenylephrine (P = 0.050), and post hoc testing indicated the difference was confined to the able-bodied-obstructive sleep apnea group (P < 0.001). No other upper airway structures showed significant changes with phenylephrine administration. In conclusion, people with obstructive sleep apnea and quadriplegia do not have a structurally smaller airway than able-bodied subjects. They did, however, have greater volumes of soft palate and lateral pharyngeal walls, possibly due to greater neck fat deposition. The acute response to upper airway topical vasoconstriction was not enhanced in those with obstructive sleep apnea and quadriplegia. Changes in upper airway anatomy likely contribute to the high incidence in obstructive sleep apnea in quadriplegic subjects.
DOI: 10.1111/jsr.12616
ORCID: 0000-0003-2543-8722
PubMed URL:
Type: Journal Article
Subjects: airway anatomy
sleep disordered breathing
spinal cord injury
Appears in Collections:Journal articles

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