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Sleep-disordered breathing and comorbidities: role of the upper airway and craniofacial skeleton

Sleep-disordered breathing and comorbidities: role of the upper airway and craniofacial skeleton
Sleep-disordered breathing and comorbidities: role of the upper airway and craniofacial skeleton

Obstructive sleep-disordered breathing (SDB), which includes primary snoring through to obstructive sleep apnea syndrome (OSAS), may cause compromise of respiratory gas exchange during sleep, related to transient upper airway narrowing disrupting ventilation, and causing oxyhemoglobin desaturation and poor sleep quality. SDB is common in chronic disorders and has significant implications for health. With prevalence rates globally increas-ing, this condition is causing a substantial burden on health care costs. Certain populations, including people with sickle cell disease (SCD), exhibit a greater prevalence of OSAS. A review of the literature provides the available normal polysomnography and oximetry data for reference and documents the structural upper airway differences between those with and without OSAS, as well as between ethnicities and disease states. There may be differences in craniofacial development due to atypical growth trajectories or extramedullary hematopoiesis in anemias such as SCD. Studies involving MRI of the upper airway illustrated that OSAS populations tend to have a greater amount of lymphoid tissue, smaller airways, and smaller lower facial skeletons from measurements of the mandible and linear mental spine to clivus. Understanding the potential relationship between these anatomical landmarks and OSAS could help to stratify treatments, guiding choice towards those which most effectively resolve the obstruction. OSAS is relatively common in SCD populations, with hypoxia as a key manifestation, and sequelae including increased risk of stroke. Combatting any structural defects with appropriate interventions could reduce hypoxic exposure and consequently reduce the risk of comorbidities in those with SDB, warranting early treatment interventions.

Adenoids, Airway, Desaturation, MRI, Obstructive sleep apnea, Polysomnography, Sickle cell
907-936
Brennan, Lucy Charlotte
fa89e00a-e2ea-4ec2-98ba-1195392b57ae
Kirkham, Fenella Jane
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Gavlak, Johanna Cristine
1897b896-c258-40f0-93b9-4c03a6caa70e
Brennan, Lucy Charlotte
fa89e00a-e2ea-4ec2-98ba-1195392b57ae
Kirkham, Fenella Jane
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Gavlak, Johanna Cristine
1897b896-c258-40f0-93b9-4c03a6caa70e

Brennan, Lucy Charlotte, Kirkham, Fenella Jane and Gavlak, Johanna Cristine (2020) Sleep-disordered breathing and comorbidities: role of the upper airway and craniofacial skeleton. Nature and Science of Sleep, 12, 907-936. (doi:10.2147/NSS.S146608).

Record type: Article

Abstract

Obstructive sleep-disordered breathing (SDB), which includes primary snoring through to obstructive sleep apnea syndrome (OSAS), may cause compromise of respiratory gas exchange during sleep, related to transient upper airway narrowing disrupting ventilation, and causing oxyhemoglobin desaturation and poor sleep quality. SDB is common in chronic disorders and has significant implications for health. With prevalence rates globally increas-ing, this condition is causing a substantial burden on health care costs. Certain populations, including people with sickle cell disease (SCD), exhibit a greater prevalence of OSAS. A review of the literature provides the available normal polysomnography and oximetry data for reference and documents the structural upper airway differences between those with and without OSAS, as well as between ethnicities and disease states. There may be differences in craniofacial development due to atypical growth trajectories or extramedullary hematopoiesis in anemias such as SCD. Studies involving MRI of the upper airway illustrated that OSAS populations tend to have a greater amount of lymphoid tissue, smaller airways, and smaller lower facial skeletons from measurements of the mandible and linear mental spine to clivus. Understanding the potential relationship between these anatomical landmarks and OSAS could help to stratify treatments, guiding choice towards those which most effectively resolve the obstruction. OSAS is relatively common in SCD populations, with hypoxia as a key manifestation, and sequelae including increased risk of stroke. Combatting any structural defects with appropriate interventions could reduce hypoxic exposure and consequently reduce the risk of comorbidities in those with SDB, warranting early treatment interventions.

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More information

Accepted/In Press date: 11 April 2019
Published date: 9 November 2020
Keywords: Adenoids, Airway, Desaturation, MRI, Obstructive sleep apnea, Polysomnography, Sickle cell

Identifiers

Local EPrints ID: 445720
URI: http://eprints.soton.ac.uk/id/eprint/445720
PURE UUID: 1c99f401-51b9-4499-8c71-1b5a48f7d838
ORCID for Fenella Jane Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 06 Jan 2021 17:41
Last modified: 28 Apr 2022 01:48

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Contributors

Author: Lucy Charlotte Brennan
Author: Johanna Cristine Gavlak

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