Effects of Head and Body Position on Two- and Three-dimensional Configurations of the Upper Airway

Abstract

This study was carried out to test the hypothesis that changes in head/body position induce changes in upper-airway dimensions. Contiguous images were obtained by means of magnetic resonance imaging in normal awake subjects during nasal breathing. A statistical analysis was made on 5 consecutive slices, including the most constricted sites in both the retropalatal and retroglossal regions. Dimensional changes in the upper airway in association with changes in head/body position were evaluated. In the retropalatal region, there was a significant decrease in the lateral dimension in the lateral recumbent position compared with that in the supine position. The cross-sectional area in the retroglossal region was significantly increased in both the "supine with the head rotated" and "lateral recumbent" positions. This change was accompanied by significant volumetric changes in the retroglossal region. Thus, sleeping with the head rotated may be effective for improving upper-airway obstruction.

Keywords

upper airway head rotation body position magnetic resonance imaging.

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References

Fleetham JA (1992). Upper airway imaging in relation to obstructive sleep apnea. Clin Chest Med 13:399-416.

George CF , Millar TW , Kryger MH (1988). Sleep apnea and body position during sleep. Sleep 11:90-99.

Jan MA , Marshall I. , Douglas NJ (1994). Effect of posture on upper airway dimensions in normal human. Am J Resp Crit Care Med 149:145-148.

Launois SH , Feroah TR , Campbell WN , Issa FG , Morrison D. , Whitelaw WA , et al. (1993). Site of pharyngeal narrowing predicts outcome of surgery for obstructive sleep apnea. Am Rev Resp Dis 147:182-189.

Liistro G. , Stanescu D. , Dooms G. , Rodenstein D. , Veriter C. (1988). Head position modifies upper airway resistance in men. J Appl Physiol 64:1285-1288.

Logemann JA , Rademaker AW , Pauloski BR , Kahrilas PJ (1994). Effects of postural change on aspiration in head and neck surgical patients. Otolaryngol Head Neck Surg 110:222-227.

Lowe AA , Gionhaku N. , Takeuchi K. , Fleetham JA (1986). Three-dimensional CT reconstructions of tongue and airway in adult subjects with obstructive sleep apnea. Am J Orthod Dentofac Orthop 90:364-374.

Martin SE , Marshall I. , Douglas NJ (1995). The effect of posture on airway caliber with the sleep-apnea/hypopnea syndrome. Am J Resp Crit Care Med 152:721-724.

Miyamoto K. , Ozbek MM , Lowe AA , Fleetham JA (1997). Effect of body position on tongue posture in awake patients with obstructive sleep apnoea. Thorax 52:255-259.

10.

Morrison DL , Launois SH , Isono S. , Feroah TR , Whitelaw WA , Remmers JE (1993). Pharyngeal narrowing and closing pressures in patients with obstructive sleep apnea. Am Rev Resp Dis 148:606-611.

11.

Otsuka R. , Ono T. , Ishiwata Y. , Kuroda T. (2000). Respiratory-related genioglossus electromyographic activity in response to head rotation and changes in body position. Angle Orthod 70:63-69.

12.

Pae EK , Lowe AA , Sasaki K. , Price C. , Tsuchiya M. , Fleetham JA (1994). A cephalometric and electromyographic study of upper airway structures in the upright and supine positions. Am J Orthod Dentofac Orthop 106:52-59.

13.

Pevernagie DA , Stanson AW , Sheedy PF 2nd , Daniels BK , Shepard JW Jr (1995). Effects of body position on the upper airway of patients with obstructive sleep apnea. Am J Resp Crit Care Med 152:179-185.

14.

Popovic RM , White DP (1995). Influence of gender on waking genioglossal electromyogram and upper airway resistance. Am J Resp Crit Care Med 152:725-731.

15.

Roberts JL , Reed WR , Thach BT (1984). Pharyngeal airway-stabilizing function of sternohyoid and sternothyroid muscles in the rabbit. J Appl Physiol 57:1790-1795.

16.

Schwab RJ , Gupta KB , Gefter WB , Metzger LJ , Hoffman EA , Pack Al (1995). Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Resp Crit Care Med 152(5 Pt 1):1673-1689.

17.

Schwab RJ (1998). Upper airway imaging. Clin Chest Med 19:33-54.

18.

Solow B. , Skov S. , Ovesen J. , Norup PW , Wildschiødtz G. (1996). Airway dimensions and head posture in obstructive sleep apnoea. Eur J Orthod 18:571-579.

19.

Takahashi S. , Ono T. , Ishiwata Y. , Kuroda T. (1999). Effect of changes in the breathing mode and body position on tongue pressure with respiratory-related oscillations. Am J Orthod Dentofac Orthop 115:239-246.

20.

Trudo FJ , Gefter WB , Welch KC , Gupta KB , Maislin G. , Schwab RJ (1998). State-related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects. Am J Resp Crit Care Med 158:1259-1270.

21.

Van de Graaff WB (1991). Thoracic traction on the trachea: mechanisms and magnitude. J Appl Physiol 70:1328-1336.

22.

Yildirim N. , Fitzpatrick MF , Whyte KF , Jalleh R. , Wightman AJ , Douglas NJ (1991). The effect of posture on upper airway dimensions in normal subjects and in patients with the sleep apnea/hypopnea syndrome . Am Rev Resp Dis 144:845-847.