ABSTRACT
Obstructive Sleep Apnea is characterized by recurrent episodes of partial or complete collapse of the pharynx, followed by decreased oxyhemoglobin saturation and frequent arousals. It is regarded as a public health issue with important night and day symptoms that impact life quality. Its effects are associated with the areas of competence of Speech and Language Pathologists. To establish efficient diagnosis and treatment methods, professionals must know the pathogenesis of upper airway obstruction during sleep. This study seeks to enlarge the understanding of obstructive sleep apnea pathophysiology, eligibility of individualized therapeutic procedures and guidance for orofacial myofunctional therapy by describing and illustrating the locations and types of upper airway collapse during sleep. We analyzed original records of Drug Induced Sleep Endoscopy exams of a series of cases with polysomnographic diagnosis of obstructive sleep apnea following the proper ethical processes. The images of the exam recordings were analyzed by five professionals with expertise in the sleep area. Obstructive sites and types of collapse were presented according to the current classification. The videos were divided into screenshots, originating figures from each anatomical site: without collapse and collapsed. The results are visualized in the images of the cases showing a predominance of velopharyngeal collapse: anteroposterior, lateral, or concentric; oropharyngeal lateral collapse; tongue anteroposterior collapse and anteroposterior collapse of the epiglottis. Understanding the obstruction sites and types of collapse illustrated in this study may help to predict therapeutic responses and learn the limitations or direct individual proposals patient.
Keywords
Obstructive Sleep Apnea; Snoring; Pharynx; Endoscopy; Myofunctional Therapy; Speech Language and Hearing Sciences
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Caption: Subject 1: Image A1 without collapse, B1 with a complete anteroposterior collapse in the velopharynxCaption: Subject 2: Image A2 without collapse, B2 with a complete anteroposterior collapse in the velopharynxCaption: Subject 3: Image A3 without collapse, B3 with a complete circumferential collapse in the velopharynx
Caption: Subject 4: Image A4 without collapse, B4 transition to lateral collapse with partial constrictions, C4 complete lateral collapse in the velopharynxCaption: Subject 5: Image A5 without collapse, B5 transition to circumferential collapse with partial constrictions, C5 complete circumferential collapse in the velopharynx
Caption: Subject 6: Image A6 without collapse, B6 with a complete collapse of the lateral walls of the oropharynxCaption: Subject 7: Image A7 without collapse, B7 with partial collapse of the lateral walls of the oropharynx
Caption: Subject 8: Image A8 base of tongue with lingual tonsil hypertrophy without hypopharyngeal collapse; B8 with a complete anteroposterior collapse in the hypopharynx with a tonsillar componentCaption: Subject 9: Image A9 base of the tongue with minimal hypertrophy of the lingual tonsil without collapse in the hypopharynx; B9 with a complete anteroposterior collapse in the hypopharynx with minimal tonsillar componentCaption: Subject 10: Image A10 base of the tongue without hypertrophy of the lingual tonsil and collapse in the hypopharynx; B10 with a complete anteroposterior collapse in the hypopharynx without tonsillar component
Caption: Subject 09: Image A11 epiglottic site without collapse, B11 complete anteroposterior collapse caused by posterior displacement of the epiglottis against the posterior hypopharyngeal wall with minimal lingual tonsillar componentCaption: Subject 11: Image A1: no collapse, B12 with complete anteroposterior collapse caused by posterior displacement of the epiglottis against the posterior hypopharyngeal wall, without lingual tonsillar component
