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Original Research |

Digital Morphometrics: A New Upper Airway Phenotyping Paradigm in Obstructive Sleep Apnea

Richard J. Schwab, MD; Sarah E. Leinwand, MPH; Cary B. Bearn, MS; Greg Maislin, MS; Ramya Bhat Rao, DMD; Adithya Nagaraja, BA; Stephen Wang, BS; Brendan T. Keenan, MS
Author and Funding Information

Author Contributions: Conception and Design: RJS, CBB, RB; Data acquisition: SEL, CBB, RB, AN, SW; Analysis and Interpretation: SEL, CBB, RB, AN, SW, GM, BTK, RJS; Drafting of the Manuscript: RJS, SEL, BTK; Critical revision: RJS, SEL, BTK; Final approval of the version to be published: SEL, CBB, RB, AN, SW, GM, BTK, RJS.

The study was performed at the University of Pennsylvania

Sources ofsupport: This investigation was supported by two National Institutes of Health Grants: HL089447 (“Obesity and OSA: Understanding the Importance of Tongue Fat & Metabolic Function”) and HL 094307 (“Understanding the Relationship Between Obesity and Tongue Fat”)

DISCLOSURE STATEMENT: The authors of this paper have nothing to disclose and there are no conflicts of interest. There is no off label use.

There are 5 Tables and 3 Figures in the main text.

This article has an online data supplement.

1Division of Sleep Medicine

2Center for Sleep & Circadian Neurobiology, Philadelphia PA

3University of Pennsylvania

Address for Correspondence: Richard J. Schwab, MD Professor, Department of Medicine Division of Sleep Medicine Pulmonary, Allergy and Critical Care Division Co-Director, Penn Sleep Center University of Pennsylvania Medical Center 3624 Market Street, Suite 205 Philadelphia, PA 19104.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.05.005
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Abstract

Background  Obstructive sleep apnea (OSA) is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy using digital morphometrics based on a laser ruler, and to assess differences between apneics and controls and associations with AHI (apnea-hypopnea index). This is the first study to use digital morphometrics to quantify intraoral risk factors for OSA.

Methods  Digital photographs were obtained using an intraoral laser ruler and digital camera in 311 controls (mean AHI=4.2 events/hour) and 533 apneics (mean AHI=39.2 events/hour).

Results  The digital morphometric paradigm was validated and reproducible over time and camera distances. A larger modified Mallampati score and having a non-visible airway were associated with a higher AHI both unadjusted (p<0.001) and controlling for age, gender, race and BMI (p=0.015 and p=0.018, respectively). Measures of tongue size were larger in apneics versus controls in unadjusted models and controlling for age, gender and race, but non-significant controlling for BMI; similar results were observed with AHI severity. Multivariate regression suggests photography-based variables capture independent associations with OSA.

Conclusions  Measures of tongue size, airway visibility and Mallampati scores were associated with increased OSA risk and severity. This study shows that digital morphometrics is an accurate, high-throughput and non-invasive technique to identify anatomic OSA risk factors. Morphometrics may also provide a more reproducible and standardized measurement of the Mallampati score. Digital morphometrics represent an efficient and cost-effective method of examining intraoral crowding and tongue size when examining large populations, genetics or screening for OSA.


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