The influence of the lateral pharyngeal wall anatomy on snoring and sleep apnoea

Objectives: To elucidate the variations of the lateral pharyngeal wall anatomy on physical examination and to assess the clinical importance of the examination of the lateral pharyngeal wall on the presence and severity of obstructive sleep apnoea syndrome. Methods: The cross-sectional study was conducted at Ege University Medical School, Izmir, Turkey, between May 2010 and April 2011. The patients were divided into four equal groups: Group 1 - snoring without apnoea (age 20- 40); Group 2 - snoring without apnoea (age 40-60); Group 3 - apnoea-hypopnoea index 5/hr; Group 4: apnoeahypopnoea index 30/hr. Calibrated oropharynx pictures were taken. Distance between palatoglossal and palatopharyngeal arches, height of palatoglossal and palatopharyngeal arches, uvula width, uvula length and distance between tonsils were measured. SPSS 17 was used for statistical analysis. Results: Of the 80 patients in the study, 44(55%) were men. Mean distance between palatopharyngeal and palatoglossal arches were 1.55±0.34cm and 2.70±0.43cm respectively. Mean height of palatopharyngeal and palatoglossal arches were 0.60±0.21cm and 1.37±0.36cm respectively (p 0.05). Mean uvula width and uvula length were 0.80±0.12cm and 1.25±0.27cm respectively (p 0.05). Mean distance between tonsils was 2.24±0.56cm (p 0.05). Distance between palatopharyngeal arches was significantly different between groups 3 and 4 (p 0.05). Conclusions: Palatopharyngeal arch anatomy was found to be significantly associated with obstructive sleep apnoea syndrome severity, especially in patients with normal or small tonsil size. Patients with the palatopharyngeal arches, which narrow the oropharyngeal inlet more than the tonsils, should further be investigated with polysomnography.