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Cited by 203Obstructive Sleep Apnea ResearchOropharyngeal Anatomy and PathologiesNeuroscience of respiration and sleep

Upper Airway Collapsibility is Associated with Obesity and Hyoid Position

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Genta, Pedro R., Schorr, Fabiola, Eckert, Danny J., Gebrim, Eloisa, Kayamori, Fabiane, Moriya, Henrique T., Malhotra, Atul, Lorenzi-Filho, Geraldo·2014·Sleep
DOI 10.5665/sleep.4078PMC PMC4173923
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Abstract

STUDY OBJECTIVES: Upper airway anatomy plays a major role in obstructive sleep apnea (OSA) pathogenesis. An inferiorly displaced hyoid as measured by the mandibular plane to hyoid distance (MPH) has been consistently associated with OSA. The hyoid is also a common landmark for pharyngeal length, upper airway volume, and tongue base. Tongue dimensions, pharyngeal length, and obesity are associated with OSA severity, although the link between these anatomical variables and pharyngeal collapsibility is less well known. We hypothesized that obesity as measured by body mass index (BMI), neck and waist circumferences, and variables associated with hyoid position (pharyngeal length, upper airway volume, and tongue dimensions) would be associated with passive pharyngeal critical closing pressure (Pcrit). DESIGN: Cross-sectional. SETTING: Academic hospital. PATIENTS: 34 Japanese-Brazilian males age 21 to 70 y. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We performed computed tomography scans of the upper airway, overnight polysomnography, and Pcrit measurements in all subjects. On average, subjects were overweight (BMI = 28 ± 4 kg/m(2)) and OSA was moderately severe (apnea-hypopnea index = 29 [13-51], range 1-90 events/h). Factor analysis identified two factors among the studied variables: obesity (extracted from BMI, neck and waist circumferences) and hyoid position (MPH, pharyngeal length, tongue length, tongue volume, and upper airway volume). Both obesity and hyoid position correlated with Pcrit (r = 0.470 and 0.630, respectively) (P < 0.01). In addition, tongue volume, tongue length, pharyngeal length, and MPH correlated with waist and neck circumferences (P < 0.05). CONCLUSIONS: Pharyngeal critical closing pressure is associated with obesity and hyoid position. Tongue dimensions, pharyngeal length, and the mandibular plane to hyoid distance are associated with obesity variables. These findings provide novel insight into the potential factors mediating upper airway collapse in obstructive sleep apnea.

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  • Greater Pcrit values are associated with an inferiorly and posteriorly positioned hyoid.

    “Genta et al. studied 34 Japanese-Brazilian men with OSA and also found an association between greater Pcrit values with an inferiorly and posteriorly positioned hyoid.338”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [338]

    The Results (page not provided) report that higher Pcrit correlated with greater mandibular-plane-to-hyoid distance, a measure of inferior hyoid position. The paper does not report an association with posterior hyoid position. It also states that 11 of the 34 Japanese-Brazilian men did not have OSA, contrary to the citing sentence's description of all 34 as having OSA. (LLM, conf=0.90)

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Authors
Genta, P. R., Schorr, F., Eckert, D. J., Gebrim, E., Kayamori, F., Moriya, H. T., Malhotra, A., & Lorenzi-Filho, G.
Affiliations
  • Brigham and Women's Hospital (US)
  • Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
  • UNSW Sydney (AU)
  • Radiology Institute (InRad), Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
  • Universidade de São Paulo (BR)
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2014-10-01
Volume
37
Issue
10
Pages
1673-1678
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.5665/sleep.4078
PMC
PMC4173923
OpenAlex
W1983589524
Semantic Scholar
3508a46a9b7c52bc84e6ea95f9c945a029ce7aad
Cited by
203
References
33
Citations by year
2026: 14 · 2025: 25 · 2024: 24 · 2023: 24 · 2022: 23 · 2021: 18 · 2020: 16 · 2019: 16 · 2018: 16 · 2017: 11 · 2016: 9 · 2015: 6 · 2014: 1
FWCI
5.98
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
  • eScholarship (California Digital Library) (submittedVersion)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
Funders
  • American Heart Association
  • Harvard University
  • Harvard Catalyst (8 UL1 TR000170-05, 8UL1TR000170)
  • Fundação de Amparo à Pesquisa do Estado de São Paulo
  • National Institutes of Health (UL1TR000170)
  • National Heart, Lung, and Blood Institute (R01HL085188)
  • National Center for Research Resources
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Health Sciences › Medicine › Rheumatology › Oropharyngeal Anatomy and Pathologies
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords
obstructive sleep apnea, upper airway collapsibility, obesity, hyoid bone position, tongue volume, tongue length, upper airway volume, body mass index, neck circumference, waist circumference, airway anatomy
MeSH terms
Adult, Aged, Brazil, Cross-Sectional Studies, Humans, Hyoid Bone, Japan, Male, Middle Aged, Neck, Obesity, Pharynx, Tongue, Body Mass Index, Polysomnography, Sleep Apnea, Obstructive, Asian People, Young Adult

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