Jagatkumar A Patel1, Bryan J Ray2, Camilo Fernandez-Salvador3, Christopher Gouveia4, Soroush Zaghi5, Macario Camacho3. 1. F. Edward Hebert School of Medicine, Uniformed Services University (USU), Bethesda, MD, 20814, USA. Electronic address: jagatkumar.a.patel.mil@mail.mil. 2. F. Edward Hebert School of Medicine, Uniformed Services University (USU), Bethesda, MD, 20814, USA. 3. Tripler Army Medical Center, Division of Otolaryngology-Head and Neck Surgery, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA. 4. Northwestern University, Feinberg School of Medicine, Department of Otolaryngology - Head and Neck Surgery, 676 N. St. Clair, Suite 1325, Chicago, IL 60611, USA. 5. UCLA Medical Center, Santa Monica, Santa Monica, CA 90404, USA.
Abstract
OBJECTIVE: A collapsible upper airway is a common cause of obstructive sleep apnea. The exact pathophysiology leading to a more collapsible airway is not well understood. A progressive neuropathy of the soft palate and pharyngeal dilators may be associated with the progression of snoring to OSA. The purpose of this study is to systematically review the international literature investigating the neurophysiologic changes in the soft palate and uvula that contribute to progression from snoring to OSA. METHODS: PubMed/MEDLINE and 4 other databases were systematically searched through July 4, 2017. Eligibility: (1) Patients: controls, snoring or OSA patients (2) Intervention: neuromuscular evaluation of the palate and/or uvula (3) Comparison: differences between controls, snoring and OSA patients (4) Outcomes: neuromuscular outcomes (5) Study design: Peer reviewed publications of any design. RESULTS: 845 studies were screened, 76 were downloaded in full text form and thirty-one studies met criteria. Histological studies of the soft palate demonstrated diffuse inflammatory changes, muscular changes consistent with neuropathy, and neural aberrancies. Sensory testing studies provided heterogeneous outcomes though the majority favored neuronal dysfunction. Studies have consistently demonstrated that increasing severity of snoring and sleep apnea is associated with worsening sensory nerve function of the palate in association with atrophic histological changes to the nerves and muscle fibers of the soft palate and uvula. CONCLUSIONS: Recent evidence highlighted in this systematic review implicates the role of neurogenic pathology underlying the loss of soft palate and/or uvular tone in the progression of snoring to sleep apnea. Published by Elsevier Inc.
OBJECTIVE: A collapsible upper airway is a common cause of obstructive sleep apnea. The exact pathophysiology leading to a more collapsible airway is not well understood. A progressive neuropathy of the soft palate and pharyngeal dilators may be associated with the progression of snoring to OSA. The purpose of this study is to systematically review the international literature investigating the neurophysiologic changes in the soft palate and uvula that contribute to progression from snoring to OSA. METHODS: PubMed/MEDLINE and 4 other databases were systematically searched through July 4, 2017. Eligibility: (1) Patients: controls, snoring or OSA patients (2) Intervention: neuromuscular evaluation of the palate and/or uvula (3) Comparison: differences between controls, snoring and OSA patients (4) Outcomes: neuromuscular outcomes (5) Study design: Peer reviewed publications of any design. RESULTS: 845 studies were screened, 76 were downloaded in full text form and thirty-one studies met criteria. Histological studies of the soft palate demonstrated diffuse inflammatory changes, muscular changes consistent with neuropathy, and neural aberrancies. Sensory testing studies provided heterogeneous outcomes though the majority favored neuronal dysfunction. Studies have consistently demonstrated that increasing severity of snoring and sleep apnea is associated with worsening sensory nerve function of the palate in association with atrophic histological changes to the nerves and muscle fibers of the soft palate and uvula. CONCLUSIONS: Recent evidence highlighted in this systematic review implicates the role of neurogenic pathology underlying the loss of soft palate and/or uvular tone in the progression of snoring to sleep apnea. Published by Elsevier Inc.
Authors: Mistyka S Schar; Taher I Omari; Charmaine M Woods; Lara F Ferris; Sebastian H Doeltgen; Kurt Lushington; Anna Kontos; Theodore Athanasiadis; Charles Cock; Ching-Li Chai Coetzer; Danny J Eckert; Eng H Ooi Journal: J Clin Sleep Med Date: 2021-09-01 Impact factor: 4.324