Download PDF
Ultrasound Int Open 2017; 03(01): E34-E42
DOI: 10.1055/s-0042-124503
Technical Development
© Georg Thieme Verlag KG Stuttgart · New York

Ultrasonographic Detection of Airway Obstruction in a Model of Obstructive Sleep Apnea

Amal Isaiah
1   Otorhinolaryngology – Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, United States
,
Reuben Mezrich
2   Radiology, University of Maryland School of Medicine, Baltimore, United States
,
Jeffrey Wolf
3   Otolaryngology – Head and Neck Surgery, University of Maryland School of medicine, Baltimore, United States
› Author Affiliations
Further Information

Publication History

received 19 July 2016
revised 06 December 2016

accepted 08 December 2016

Publication Date:
22 March 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Purpose Obstructive sleep apnea (OSA) is a common clinical disorder characterized by repetitive airway obstruction during sleep. The gold standard for diagnosis of OSA, polysomnogram (PSG), cannot anatomically localize obstruction. Precise identification of obstruction has potential to improve outcomes following surgery. Current diagnostic modalities that provide this information require anesthesia, involve ionizing radiation or disrupt sleep. To mitigate these problems, we conceived that ultrasound (US) technology may be adapted (i) to detect, quantify and localize airway obstruction and (ii) for translational application to home-based testing for OSA.

Materials and Methods Segmental airway collapse was induced in 4 fresh cadavers by application of negative pressure. Following visualization of airway obstruction, a rotary US probe was used to acquire transcervical images of the airway before and after induction of obstruction. These images (n=800) were analyzed offline using image processing algorithms.

Results Our results show that the non-obstructed airway consistently demonstrated the presence of a US air-tissue interface. Importantly, automated detection of the air-tissue interface strongly correlated with manual measurements. The algorithm correctly detected an air-tissue interface in 90% of the US images while incorrectly detecting it in 20% (area under the curve=0.91).

Conclusion The non-invasive detection of airway obstruction using US represents a major step in expanding OSA diagnostics beyond PSG. The preliminary data obtained from our model could spur further research in non-invasive localization of obstruction. US offers the benefit of precise localization of the site of obstruction, with potential for improving outcomes in surgical management

Key words

head/neck - ultrasound - segmentation - technical aspects
 

  • References

  • 1 Strollo PJJ, Rogers RM. Obstructive sleep apnea. N Engl J Med 1996; 334: 99-104
    Google Scholar
  • 2 Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000; 283: 1829-1836
    CrossrefPubMedGoogle Scholar
  • 3 Coughlin SR, Mawdsley L, Mugarza JA, Calverley PMA, Wilding JPH. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004; 25: 735-741
    CrossrefPubMedGoogle Scholar
  • 4 Findley LJ, Barth JT, Powers DC, Wilhoit SC, Boyd DG, Suratt PM. Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia. Chest 1986; 90: 686-690
    CrossrefPubMedGoogle Scholar
  • 5 Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest 1988; 94: 1200-1204
    CrossrefPubMedGoogle Scholar
  • 6 Monasterio C, Vidal S, Duran J, Ferrer M, Carmona C, Barbe F et al. Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 2001; 164: 939-943
    CrossrefPubMedGoogle Scholar
  • 7 Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med 2009; 5: 263-276
    PubMedGoogle Scholar
  • 8 Pang KP, Gourin CG, Terris DJ. A comparison of polysomnography and the WatchPAT in the diagnosis of obstructive sleep apnea. Otolaryngol–Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 2007; 137: 665-668
    PubMedGoogle Scholar
  • 9 Chiner E, Signes-Costa J, Arriero JM, Marco J, Fuentes I, Sergado A. Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies?. Thorax 1999; 54: 968-971
    CrossrefPubMedGoogle Scholar
  • 10 Rama AN, Tekwani SH, Kushida CA. Sites of obstruction in obstructive sleep apnea. Chest 2002; 122: 1139-1147
    CrossrefPubMedGoogle Scholar
  • 11 Shepard JWJ, Thawley SE. Localization of upper airway collapse during sleep in patients with obstructive sleep apnea. Am Rev Respir Dis 1990; 141: 1350-1355
    CrossrefPubMedGoogle Scholar
  • 12 Lowe AA, Fleetham JA, Adachi S, Ryan CF. Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod 1995; 107: 589-595
    PubMedGoogle Scholar
  • 13 Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003; 168: 522-530
    CrossrefPubMedGoogle Scholar
  • 14 Sustic A. Role of ultrasound in the airway management of critically ill patients. Crit Care Med 2007; 35: S173-S177
    CrossrefPubMedGoogle Scholar
  • 15 Solbiati L, Osti V, Cova L, Tonolini M. Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol 2001; 11: 2411-2424
    CrossrefPubMedGoogle Scholar
  • 16 Prasad A, Yu E, Wong DT, Karkhanis R, Gullane P, Chan VWS. Comparison of sonography and computed tomography as imaging tools for assessment of airway structures. J Ultrasound Med Off J Am Inst Ultrasound Med 2011; 30: 965-972
    PubMedGoogle Scholar
  • 17 Or DYL, Karmakar MK, Lam GCS, Hui JWY, Li JW, Chen PP. Multiplanar 3D ultrasound imaging to assess the anatomy of the upper airway and measure the subglottic and tracheal diameters in adults. Br J Radiol 2013; 86: 20130253
    CrossrefPubMedGoogle Scholar
  • 18 Chen J-W, Chang C-H, Wang S-J, Chang Y-T, Huang C-C. Submental ultrasound measurement of dynamic tongue base thickness in patients with obstructive sleep apnea. Ultrasound Med Biol 2014; 40: 2590-2598
    CrossrefPubMedGoogle Scholar
  • 19 Shu C-C, Lee P, Lin J-W, Huang C-T, Chang Y-C, Yu C-J et al. The use of sub-mental ultrasonography for identifying patients with severe obstructive sleep apnea. PloS One 2013; 8: e62848
    CrossrefPubMedGoogle Scholar
  • 20 Aldrich JE. Basic physics of ultrasound imaging. Crit Care Med 2007; 35: S131-S137
    CrossrefPubMedGoogle Scholar
  • 21 Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev 2010; 90: 47-112
    CrossrefPubMedGoogle Scholar
  • 22 Polat K, Yosunkaya S, Gunes S. Comparison of different classifier algorithms on the automated detection of obstructive sleep apnea syndrome. J Med Syst 2008; 32: 243-250
    CrossrefPubMedGoogle Scholar
  • 23 Crumley RL, Stein M, Gamsu G, Golden J, Dermon S. Determination of obstructive site in obstructive sleep apnea. The Laryngoscope 1987; 97: 301-308
    PubMedGoogle Scholar
  • 24 Stuck BA, Maurer JT. Airway evaluation in obstructive sleep apnea. Sleep Med Rev 2008; 12: 411-436
    CrossrefPubMedGoogle Scholar