Correlation between airway size and imaging examination in OSAHS patients

Correlation between airway size and imaging examination in OSAHS patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlation between airway size and imaging examination in OSAHS patients Yuanzhi Bie, Qian Zhou, dong Ding, xiuqin Ren, guanglun Wan, yinfeng Wang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4569181/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The relationship between polysomnography (PSG) and three-dimensional computed tomography (3D-CT) hasn't been well investigated in Obstructive sleep apnea/hypopnea syndrome (OSAHS) . Objectives By analyzing PSG and 3D-CT, we obtain anatomical factors that affect the severity of OSAHS. Methods 78 OSAHS patients were retrospectively analyzed who were admitted to the First Affiliated Hospital of University of Science and Technology of China from January 1, 2022 to November 1, 2023. All of them had completed PSG and upper airway 3D-CT. The correlation between PSG and 3D-CT parameters was analyzed in these OSAHS patients. Results The study showed that body mass index (BMI) was significantly correlated with the diameter of soft palate (r = 0.359, p < 0.05). Apnea-hypopnea index (AHI) was significantly correlated with soft palate diameter (r = 0.258, p < 0.05). Mean blood oxygen saturation (MSaO2%) was significantly correlated with the length of soft palate (r= -0.330, p < 0.05). The lowest blood oxygen saturation (LSaO2%) was significantly correlated with the airway area at the level of free edge of epiglottis (r = 0.266, p < 0.05). The cumulative time of oxygen saturation below 90% (CT90) was significantly correlated with the length of soft palate (r = 0.271, p < 0.05). CT90 was positively correlated with the diameter of soft palate (r = 0.269, p < 0.05). Other upper airway anatomical parameters, such as distance from uvula to epiglottis (UED), uvula diameter (UD), posterior pharyngeal wall thickness (PWD), hard palate horizontal airway area (HPA), uvula apex horizontal airway area (UA), hyoid horizontal airway area (HA), were not clearly correlated with AHI and blood oxygen saturation. Conclusion and significance The severity of OSAHS is mainly affected by the diameter and length of the soft palate, and the treatment of soft palate is the key to the surgical treatment of OSAHS. In patients with low minimum blood oxygenation, the treatment should focus on expanding the airway area in the plane of the free edge of the epiglottis. Obstructive sleep apnea hypopnea syndrome Polysomnography Upper airway Figures Figure 1 Introduction Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a common sleep disorder characterized by recurrent upper airway collapse and obstruction during sleep [ 1 ] . Polysomnography (PSG) is considered the gold standard for diagnosing OSAHS. PSG is mainly used to diagnose OSAHS and estimate the severity of OSAHS. However, when conservative treatment fails or compliance is poor and surgical treatment is considered, it is very necessary to determine the location of airway collapse, which mainly relies on imaging examinations. Three-dimensional reconstruction computed tomography (3D-CT) image quantitative analysis is the most effective imaging examination to evaluate the anatomical factors of OSAHS, which is used to evaluate the upper airway and assist in surgical planning [ 2 ] . 3D-CT of the upper airway allows detailed imaging of the bones and soft tissues of the upper airway from the nasopharynx to the larynx. By acquiring high-resolution images with a layer thickness of 1–2 mm in the axial plane and performing three-dimensional reconstruction of the airway, length and cross-sectional measurements can be performed with high precision to more accurately assess the condition of the airway. This article aims to analyze the PSG and upper airway 3D-CT of OSAHS patients to find out the anatomical factors that affect the severity of OSAHS and provide valuable information for clinical diagnosis and surgical treatment. Materials and Methods Data collection We retrospectively analyzed 78 OSAHS patients who were admitted to the First Affiliated Hospital of University of Science and Technology of China from January 1, 2022 to November 1, 2023. All of them had completed PSG and upper airway 3D-CT. This study was the ethics committee of our hospital approved the study, and all patients informed and signed consent forms. Inclusion criteria Participants aged 18 to 65 years old can undergo upper airway 3D-CT and overnight PSG, and have more than 30 repeated episodes of apnea and hypopnea during 7 hours of sleep every night, or patients with AHI > 5 events/h. Participants were previously evaluated clinically for signs and symptoms associated with sleep-disordered breathing (e.g., snoring, daytime sleepiness, witnessed apnea during sleep, and asphyxia) and definitely diagnosed with OSAHS. Exclusion criteria Patients under 18 years old or over 65 years old, patients with previous maxillofacial or upper airway surgery, pregnant or suspected pregnant patients, patients with maxillofacial or airway deformities, maxillofacial or airway tumors, central or patients with mixed sleep apnea, combined with pneumothorax, pleural effusion and other chest diseases, severe liver and kidney dysfunction, long-term oral or injected sedative and analgesic drugs. PSG An overnight polysomnography system was used to perform PSG [ 3 ] . Sleep quality was evaluated using the 2012 American Orthopedic Association (AASM) standards [ 4 ] . The weight and height of all study subjects were recorded by a sleep disorder specialist, and the body mass index (BMI) was calculated by dividing the weight (kg) by the square of the height (m). The apnea/hypopnea index (AHI) is calculated by dividing apnea and hypopnea events by sleep time. Record the average blood oxygen saturation (MSaO 2 %) and the lowest blood oxygen saturation (LSaO 2 %) during sleep. Record the proportion of time when blood oxygen saturation is less than 90% to total sleep time (CT90). 3D-CT All patients underwent Muller's test, that is, after the patient breathed calmly for several times, he pinched his nose and closed his mouth and inhaled deeply to simulate sleep state. During the Muller's test, upper airway 3D-CT was performed, and the upper airway was obtained by the same radiologist. Axial airway images and three-dimensional reconstructed images were taken, and the area and length were measured using software. We selected four axial images: the airway area at the level of the hard palate, the airway area at the level of the uvula tip, the airway area at the free edge of the epiglottis, and the airway area at the hyoid level, and five three-dimensional reconstructed images: the uvula to Epiglottis distance, uvula vertical diameter, soft palate length, soft palate diameter, and posterior pharyngeal wall soft tissue thickness. Statistical Analysis SPSS 22.0 software package was used for statistical analysis, and Pearson correlation coefficient was used to analyze the relationship between each upper airway 3D-CT measurement result and each PSG monitoring result. In all analyses, p values < 0.05 were considered to indicate statistically significant differences. Results Baseline demographic and clinical characteristics A total of 78 patients with OSAHS were reviewed in this study, including 71 males and 7 females, with an average age of 36.31 years, and an average BMI of 27.65. Among them, there were 11 patients with mild OSAHS, 10 with moderate OSAHS, and 57 with severe OSAHS. The soft tissue thickness of the posterior pharyngeal wall was 0.90, and the airway area at the level of the hard palate was 3.53. Soft palate length and diameter There is a significant correlation between BMI and soft palate diameter ( r = 0.359, p < 0.05). The higher the BMI value, the wider the soft palate diameter,. There is a significant correlation between AHI and soft palate diameter ( r = 0.258, p < 0.05). The wider the soft palate diameter, the higher the AHI value. There is a significant correlation between MSaO 2 % and the length of the soft palate ( r = -0.330, p < 0.05). The longer the length of the soft palate, the lower the MSaO 2 %. CT90 is correlated with the length of the soft palate ( r = 0.271, p < 0.05). The correlation between CT90 and soft palate diameter ( r = 0.269, p < 0.05) is significant. The longer the soft palate length, the higher the CT90. The correlation between CT90 and soft palate diameter ( r = 0.269, p < 0.05) is significant. The wider the soft palate diameter, the higher the CT90. Airway area at the level of the free edge of the epiglottis There is a significant correlation between LSaO 2 % and the airway area at the level of the free edge of the epiglottis ( r = 0.266, p < 0.05). The smaller the airway area at the level of the free edge of the epiglottis, the lower the LSaO 2 %. The remaining The horizontal airway area of the hard palate, the horizontal airway area of the uvula tip, the horizontal airway area of the hyoid bone, as well as the distance from the uvula to the epiglottis, the vertical diameter of the uvula, and the thickness of the soft tissue of the posterior pharyngeal wall. The above indicators have no significance on the PSG results. Discussion The incidence of sleep apnea syndrome is increasing day by day. PSG is the gold standard test for diagnosing OSAHS. However, the determination of specific treatment plans also requires other auxiliary examinations, such as upper airway 3D-CT, electronic laryngoscopy and other examinations. 3D-CT images have high resolution, which can clearly display the morphology of the upper respiratory tract and its relationship with surrounding tissues, and can accurately measure the cross-sectional area of the upper respiratory tract on different planes, and the length and thickness of the pharyngeal structure. Upper airway 3D-CT has become a common method to determine the location of airway obstruction before surgery [ 5 ] . PSG combined with upper airway 3D-CT can be used to evaluate the structural factors affecting OSAHS and to design specific surgical plans for OSAHS. There are many surgical treatments for OSAHS, such as uvulopalatopharyngoplasty(UPPP),genioglossus advancement,hyoid myotomy, maxillomandibular advancement and tracheotomy, etc., which can all be used for treatment. Obstructive sleep apnea. However, selecting the most appropriate surgical approach for these patients remains an unresolved issue. This study shows that the following three imaging indicators have a significant impact on PSG: soft palate diameter, soft palate length, and airway area at the level of the free edge of the epiglottis. The area of the horizontal airway of the hard palate, the area of the horizontal airway of the uvula tip, the area of the horizontal airway of the hyoid bone, as well as the distance from the uvula to the epiglottis, the vertical diameter of the uvula, and the thickness of the soft tissue of the posterior pharyngeal wall. The above indicators have no significant effect on the sleep test results. It shows that the anatomical structures that have a greater impact on patients with sleep apnea syndrome are mainly the soft palate and the epiglottis plane airway. This is consistent with the results of Abramson ZR et al. Abramson ZR et al. [ 6 ] point out that 3D-CT can predict the severity of OSAHS by assessing the size and shape of the airway and provide treatment options. However, it is inconsistent with the study by Shigeta Y et al. [ 7 ] , which pointed out that there is no significant relationship between BMI, AHI and airway area in patients with OSAHS. Rodrigues MM et al. [ 8 ] also found that there is no correlation between the total volume of the oropharynx and upper pharynx and AHI. Pharyngeal volume cannot predict the severity of OSAHS, possibly because the volume of the pharynx is not static but dynamic. Yes, it is affected by swallowing, breathing and body posture. This study found that the diameter of the soft palate has a significant positive correlation with the BMI value and the AHI value. At the same time, the length of the soft palate has an impact on MSaO 2 % and CT90. These indicate that the soft palate is the most important anatomical factor affecting the severity of OSAHS, which is consistent with The study by Passos UL et al. [ 9 ] is basically consistent. The study found that the retropalatal area is the main site of upper airway obstruction in OSA patients during sleep. This obstruction is caused by the associated anteroposterior and lateral stenosis. Sakat MS et al. [ 10 ] found that the length of the soft palate in OSAHS patients was significantly longer than that in the normal population, but the thickness of the soft palate in OSAHS patients was not significantly increased compared with the normal population. The surgeries we perform today only target the soft palate, such as uvulopalatopharyngoplasty (UPPP). However, this type of surgery not only operates on the soft palate, but also includes the treatment of the uvula. In this study, it was found that the horizontal airway area at the tip of the uvula, the distance from the uvula to the epiglottis, and the vertical diameter of the uvula had no significant impact on sleep monitoring indicators. In other words, the size of the uvula has no direct relationship with sleep apnea.This is inconsistent with the study of Chang ET et al. Chang ET et al. [ 11 ] point out that there is a significant direct relationship between the size of the uvula and sleep apnea, which is positively associated with the severity of OSAHS. This suggests that measuring the size of the uvula can help in the overall decision-making for snoring surgery options.This study shows that there is no significant correlation between the size of the uvula and the severity of OSAHS. This may be due to the following reasons. Tang XL et al. [ 12 ] points out that the collapse caused by the compensatory dysfunction of pharyngeal dilatation muscles during sleep is different from the airway collapse caused by simulated negative pressure in the Müller test in the awake state. In this study, the Müller test was used to simulate the airway collapse during sleep, which may cause bias in the results. However, Lan Z et al. [ 13 ] found that there is a high correlation between the cross-sectional area of the upper airway in the awake and sleeping states. There is a significant correlation between LSaO 2 % and the airway area at the level of the free edge of the epiglottis. The smaller the airway area at the level of the free edge of the epiglottis, the lower the minimum blood oxygen, that is, the more severe the patient's sleep apnea syndrome. This shows that for patients with low minimum blood oxygenation, the airway area at the free edge of the epiglottis should be expanded, and glossopharyngeal surgery may be required to expand the airway area. Mahale AR et al. [ 14 ] pointed out upper airway collapse almost always occurs at the oropharyngeal level, but the cross-sectional area of the subpharyngeal airway in patients with severe OSAHS is significantly larger than that of the normal population. Wu D et al. [ 15 ] pointed out that for severe patients with Friedman stages III and IV, if only UPPP is used for treatment, the chance of success is very low. Therefore, Friedman staging is used by many experts to identify patients who may have retrolingual airway obstruction. The complexity of glossopharyngeal airway obstruction has led to the diversity of surgeries in the retrolingual region, such as genioglossal muscle extension, midline tongue incision, tongue base suspension suture, temperature-controlled radiofrequency tongue repositioning, etc. In summary, for patients with low minimum blood oxygenation, glossopharyngeal surgery may be required to achieve better results. The severity of OSAHS is mainly affected by the diameter and length of the soft palate, and the treatment of the soft palate is the key to surgical treatment. For the treatment of patients with low minimum blood oxygenation, the focus needs to be on expanding the airway area in the plane of the free edge of the epiglottis. In short, PSG and upper airway 3D-CT need to be carefully analyzed before surgery to provide patients with more effective and appropriate treatment options. Declarations Disclosure statement No potential conflict of interest was reported by the author(s) Author Contribution B,Z,D,R,W,W,S,S and Q all co-authored the manuscript of the main text, and all authors reviewed the manuscript. Acknowledgments The authors sincerely thank all the teachers who have made important contributions to the publication of this article. Ethical approval: All codes of practice and standards involved in this study were in accordance with the Declaration of Helsinki, and all studies were approved by the Ethics Committee of our hospital. Agree to publish: All researchers involved in this paper gave their consent for publication. References Gottlieb DJ, Punjabi NM. Diagnosis and Management of Obstructive Sleep Apnea: A Review. JAMA. 2020;323(14):1389–400. Koren A, Groselj LD, Fajdiga I. CT comparison of primary snoring and obstructive sleep apnea syndrome: role of pharyngeal narrowing ratio and soft palate-tongue contact in awake patient. Eur Arch Otorhinolaryngol. 2009;266(5):727–34. Markun LC, Sampat A. Clinician-Focused Overview and Developments in Polysomnography. Curr Sleep Med Rep. 2020;6(4):309–21. Berry RB, Brooks R, Gamaldo C, et al. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med. 2017;13(5):665–6. Zeiberg AS, Silverman PM, Sessions RB, et al. Helical (spiral) CT of the upper airway with three-dimensional imaging: technique and clinical assessment. AJR Am J Roentgenol. 1996;166(2):293–9. Abramson ZR, Susarla S, Tagoni JR, et al. Three-dimensional computed tomographic analysis of airway anatomy. J Oral Maxillofac Surg. 2010;68(2):363–71. Shigeta Y, Enciso R, Ogawa T, et al. Correlation between retroglossal airway size and body mass index in OSA and non-OSA patients using cone beam CT imaging. Sleep Breath. 2008;12(4):347–52. Rodrigues MM, Pereira Filho VA, Gabrielli MFR, et al. Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients. Braz J Otorhinolaryngol. 2017;84(1):89–94. Passos UL, Genta PR, Marcondes BF, et al. State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea. J Bras Pneumol. 2019;45(4):e20180264. Sakat MS, Sütbeyaz Y, Yüceler Z, et al. Cephalometric Measurements With Multislice Computed Tomography in Patients With Obstructive Sleep Apnea Syndrome. J Craniofac Surg. 2016;27(1):82–6. Chang ET, Baik G, Torre C, et al. The relationship of the uvula with snoring and obstructive sleep apnea: a systematic review. Sleep Breath. 2018;22(4):955–61. Tang XL, Yi HL, Luo HP, et al. The application of CT to localize the upper airway obstruction plane in patients with OSAHS. Otolaryngol Head Neck Surg. 2012;147(6):1148–53. Lan Z, Itoi A, Takashima M, et al. Difference of pharyngeal morphology and mechanical property between OSAHS patients and normal subjects. Auris Nasus Larynx. 2006;33:433–9. Mahale AR, Rao P, Ullal S, et al. Computed Tomography and Cephalometric Evaluation of Obstructive Sleep Apnea Syndrome. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):5134–43. Wu D, Shi H, Guo X, et al. Predictive value of lingua/pharynx ratio for retroglossal obstruction in patients with obstructive sleep apnea hypopnea syndrome. Acta Otolaryngol. 2013;133(5):504–8. Tables Table 1 Definition of airway parameters Symbol Definition Unit UED Distance from uvula to epiglottis cm UD Uvula diameter cm SPL Soft palate length cm SPD Soft palate diameter cm PWD posterior pharyngeal wall thickness cm HPA Hard palate horizontal airway area cm 2 UA Uvula apex horizontal airway area cm 2 EA Free edge of epiglottis horizontal airway area cm 2 HA Hyoid horizontal airway area cm 2 Table 2 Baseline demographic and clinical characteristics Epidemiology characteristics Gender (N) Male:71 Femal: 7 Age 36.31 BMI 27.65 Severity of OSAHS (N) Mild:11 Moderate:10 Heavy:57 Upper airway parameters Uvula diameter 0.89 Soft palate length 2.17 Soft palate diameter 0.88 Posterior pharyngeal wall thickness 0.90 Hard palate horizontal airway area 3.53 Table 3 Correlation coefficients of PSG and 3D-CT, * p < 0.05 r UED UD SPL SPD PWD HPA UA EA HA BMI(kg/m 2 ) 0.015 0.141 0.142 0.359* 0.036 0.203 -0.040 -0.046 -0.001 AHI (/h) 0.004 0.026 0.142 0.258* -0.047 0.049 0.030 -0.093 0.007 MSaO2 (%) 0.003 -0.075 -0.330* -0.117 -0.172 -0.180 0.005 0.113 -0.003 LSaO2 (%) -0.068 -0.132 -0.213 -0.096 -0.111 -0.246 -0.120 0.266* -0.015 CT90(%) 0.021 0.096 0.271* 0.269* 0.284 0.168 -0.024 -0.181 -0.056 Additional Declarations No competing interests reported. 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Polysomnography (PSG) is considered the gold standard for diagnosing OSAHS. PSG is mainly used to diagnose OSAHS and estimate the severity of OSAHS. However, when conservative treatment fails or compliance is poor and surgical treatment is considered, it is very necessary to determine the location of airway collapse, which mainly relies on imaging examinations. Three-dimensional reconstruction computed tomography (3D-CT) image quantitative analysis is the most effective imaging examination to evaluate the anatomical factors of OSAHS, which is used to evaluate the upper airway and assist in surgical planning \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. 3D-CT of the upper airway allows detailed imaging of the bones and soft tissues of the upper airway from the nasopharynx to the larynx. By acquiring high-resolution images with a layer thickness of 1\u0026ndash;2 mm in the axial plane and performing three-dimensional reconstruction of the airway, length and cross-sectional measurements can be performed with high precision to more accurately assess the condition of the airway. This article aims to analyze the PSG and upper airway 3D-CT of OSAHS patients to find out the anatomical factors that affect the severity of OSAHS and provide valuable information for clinical diagnosis and surgical treatment.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eWe retrospectively analyzed 78 OSAHS patients who were admitted to the First Affiliated Hospital of University of Science and Technology of China from January 1, 2022 to November 1, 2023. All of them had completed PSG and upper airway 3D-CT. This study was the ethics committee of our hospital approved the study, and all patients informed and signed consent forms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eParticipants aged 18 to 65 years old can undergo upper airway 3D-CT and overnight PSG, and have more than 30 repeated episodes of apnea and hypopnea during 7 hours of sleep every night, or patients with AHI\u0026thinsp;\u0026gt;\u0026thinsp;5 events/h. Participants were previously evaluated clinically for signs and symptoms associated with sleep-disordered breathing (e.g., snoring, daytime sleepiness, witnessed apnea during sleep, and asphyxia) and definitely diagnosed with OSAHS.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003ePatients under 18 years old or over 65 years old, patients with previous maxillofacial or upper airway surgery, pregnant or suspected pregnant patients, patients with maxillofacial or airway deformities, maxillofacial or airway tumors, central or patients with mixed sleep apnea, combined with pneumothorax, pleural effusion and other chest diseases, severe liver and kidney dysfunction, long-term oral or injected sedative and analgesic drugs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePSG\u003c/h2\u003e \u003cp\u003eAn overnight polysomnography system was used to perform PSG \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Sleep quality was evaluated using the 2012 American Orthopedic Association (AASM) standards \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The weight and height of all study subjects were recorded by a sleep disorder specialist, and the body mass index (BMI) was calculated by dividing the weight (kg) by the square of the height (m). The apnea/hypopnea index (AHI) is calculated by dividing apnea and hypopnea events by sleep time. Record the average blood oxygen saturation (MSaO\u003csub\u003e2\u003c/sub\u003e%) and the lowest blood oxygen saturation (LSaO\u003csub\u003e2\u003c/sub\u003e%) during sleep. Record the proportion of time when blood oxygen saturation is less than 90% to total sleep time (CT90).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3D-CT\u003c/h2\u003e \u003cp\u003eAll patients underwent Muller's test, that is, after the patient breathed calmly for several times, he pinched his nose and closed his mouth and inhaled deeply to simulate sleep state. During the Muller's test, upper airway 3D-CT was performed, and the upper airway was obtained by the same radiologist. Axial airway images and three-dimensional reconstructed images were taken, and the area and length were measured using software. We selected four axial images: the airway area at the level of the hard palate, the airway area at the level of the uvula tip, the airway area at the free edge of the epiglottis, and the airway area at the hyoid level, and five three-dimensional reconstructed images: the uvula to Epiglottis distance, uvula vertical diameter, soft palate length, soft palate diameter, and posterior pharyngeal wall soft tissue thickness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eSPSS 22.0 software package was used for statistical analysis, and Pearson correlation coefficient was used to analyze the relationship between each upper airway 3D-CT measurement result and each PSG monitoring result. In all analyses, \u003cem\u003ep\u003c/em\u003e values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered to indicate statistically significant differences.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eBaseline demographic and clinical characteristics\u003c/h2\u003e \u003cp\u003eA total of 78 patients with OSAHS were reviewed in this study, including 71 males and 7 females, with an average age of 36.31 years, and an average BMI of 27.65. Among them, there were 11 patients with mild OSAHS, 10 with moderate OSAHS, and 57 with severe OSAHS. The soft tissue thickness of the posterior pharyngeal wall was 0.90, and the airway area at the level of the hard palate was 3.53.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSoft palate length and diameter\u003c/h2\u003e \u003cp\u003eThere is a significant correlation between BMI and soft palate diameter (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.359, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The higher the BMI value, the wider the soft palate diameter,. There is a significant correlation between AHI and soft palate diameter (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.258, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The wider the soft palate diameter, the higher the AHI value. There is a significant correlation between MSaO\u003csub\u003e2\u003c/sub\u003e% and the length of the soft palate (\u003cem\u003er\u003c/em\u003e= -0.330, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The longer the length of the soft palate, the lower the MSaO\u003csub\u003e2\u003c/sub\u003e%. CT90 is correlated with the length of the soft palate (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.271, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The correlation between CT90 and soft palate diameter (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.269, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) is significant. The longer the soft palate length, the higher the CT90. The correlation between CT90 and soft palate diameter (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.269, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) is significant. The wider the soft palate diameter, the higher the CT90.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAirway area at the level of the free edge of the epiglottis\u003c/h2\u003e \u003cp\u003eThere is a significant correlation between LSaO\u003csub\u003e2\u003c/sub\u003e% and the airway area at the level of the free edge of the epiglottis (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.266, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The smaller the airway area at the level of the free edge of the epiglottis, the lower the LSaO\u003csub\u003e2\u003c/sub\u003e%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eThe remaining\u003c/h2\u003e \u003cp\u003eThe horizontal airway area of the hard palate, the horizontal airway area of the uvula tip, the horizontal airway area of the hyoid bone, as well as the distance from the uvula to the epiglottis, the vertical diameter of the uvula, and the thickness of the soft tissue of the posterior pharyngeal wall. The above indicators have no significance on the PSG results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe incidence of sleep apnea syndrome is increasing day by day. PSG is the gold standard test for diagnosing OSAHS. However, the determination of specific treatment plans also requires other auxiliary examinations, such as upper airway 3D-CT, electronic laryngoscopy and other examinations. 3D-CT images have high resolution, which can clearly display the morphology of the upper respiratory tract and its relationship with surrounding tissues, and can accurately measure the cross-sectional area of the upper respiratory tract on different planes, and the length and thickness of the pharyngeal structure. Upper airway 3D-CT has become a common method to determine the location of airway obstruction before surgery \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. PSG combined with upper airway 3D-CT can be used to evaluate the structural factors affecting OSAHS and to design specific surgical plans for OSAHS. There are many surgical treatments for OSAHS, such as uvulopalatopharyngoplasty(UPPP),genioglossus advancement,hyoid myotomy, maxillomandibular advancement and tracheotomy, etc., which can all be used for treatment. Obstructive sleep apnea. However, selecting the most appropriate surgical approach for these patients remains an unresolved issue.\u003c/p\u003e \u003cp\u003eThis study shows that the following three imaging indicators have a significant impact on PSG: soft palate diameter, soft palate length, and airway area at the level of the free edge of the epiglottis. The area of the horizontal airway of the hard palate, the area of the horizontal airway of the uvula tip, the area of the horizontal airway of the hyoid bone, as well as the distance from the uvula to the epiglottis, the vertical diameter of the uvula, and the thickness of the soft tissue of the posterior pharyngeal wall. The above indicators have no significant effect on the sleep test results. It shows that the anatomical structures that have a greater impact on patients with sleep apnea syndrome are mainly the soft palate and the epiglottis plane airway. This is consistent with the results of Abramson ZR et al. Abramson ZR et al.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e point out that 3D-CT can predict the severity of OSAHS by assessing the size and shape of the airway and provide treatment options. However, it is inconsistent with the study by Shigeta Y et al.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, which pointed out that there is no significant relationship between BMI, AHI and airway area in patients with OSAHS. Rodrigues MM et al.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003ealso found that there is no correlation between the total volume of the oropharynx and upper pharynx and AHI. Pharyngeal volume cannot predict the severity of OSAHS, possibly because the volume of the pharynx is not static but dynamic. Yes, it is affected by swallowing, breathing and body posture.\u003c/p\u003e \u003cp\u003eThis study found that the diameter of the soft palate has a significant positive correlation with the BMI value and the AHI value. At the same time, the length of the soft palate has an impact on MSaO\u003csub\u003e2\u003c/sub\u003e% and CT90. These indicate that the soft palate is the most important anatomical factor affecting the severity of OSAHS, which is consistent with The study by Passos UL et al. \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e is basically consistent. The study found that the retropalatal area is the main site of upper airway obstruction in OSA patients during sleep. This obstruction is caused by the associated anteroposterior and lateral stenosis. Sakat MS et al. \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e found that the length of the soft palate in OSAHS patients was significantly longer than that in the normal population, but the thickness of the soft palate in OSAHS patients was not significantly increased compared with the normal population. The surgeries we perform today only target the soft palate, such as uvulopalatopharyngoplasty (UPPP). However, this type of surgery not only operates on the soft palate, but also includes the treatment of the uvula. In this study, it was found that the horizontal airway area at the tip of the uvula, the distance from the uvula to the epiglottis, and the vertical diameter of the uvula had no significant impact on sleep monitoring indicators. In other words, the size of the uvula has no direct relationship with sleep apnea.This is inconsistent with the study of Chang ET et al. Chang ET et al.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e point out that there is a significant direct relationship between the size of the uvula and sleep apnea, which is positively associated with the severity of OSAHS. This suggests that measuring the size of the uvula can help in the overall decision-making for snoring surgery options.This study shows that there is no significant correlation between the size of the uvula and the severity of OSAHS. This may be due to the following reasons. Tang XL et al.\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e points out that the collapse caused by the compensatory dysfunction of pharyngeal dilatation muscles during sleep is different from the airway collapse caused by simulated negative pressure in the M\u0026uuml;ller test in the awake state. In this study, the M\u0026uuml;ller test was used to simulate the airway collapse during sleep, which may cause bias in the results. However, Lan Z et al.\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003efound that there is a high correlation between the cross-sectional area of the upper airway in the awake and sleeping states.\u003c/p\u003e \u003cp\u003eThere is a significant correlation between LSaO\u003csub\u003e2\u003c/sub\u003e% and the airway area at the level of the free edge of the epiglottis. The smaller the airway area at the level of the free edge of the epiglottis, the lower the minimum blood oxygen, that is, the more severe the patient's sleep apnea syndrome. This shows that for patients with low minimum blood oxygenation, the airway area at the free edge of the epiglottis should be expanded, and glossopharyngeal surgery may be required to expand the airway area. Mahale AR et al. \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003epointed out upper airway collapse almost always occurs at the oropharyngeal level, but the cross-sectional area of the subpharyngeal airway in patients with severe OSAHS is significantly larger than that of the normal population. Wu D et al. \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003epointed out that for severe patients with Friedman stages III and IV, if only UPPP is used for treatment, the chance of success is very low. Therefore, Friedman staging is used by many experts to identify patients who may have retrolingual airway obstruction. The complexity of glossopharyngeal airway obstruction has led to the diversity of surgeries in the retrolingual region, such as genioglossal muscle extension, midline tongue incision, tongue base suspension suture, temperature-controlled radiofrequency tongue repositioning, etc. In summary, for patients with low minimum blood oxygenation, glossopharyngeal surgery may be required to achieve better results.\u003c/p\u003e \u003cp\u003eThe severity of OSAHS is mainly affected by the diameter and length of the soft palate, and the treatment of the soft palate is the key to surgical treatment. For the treatment of patients with low minimum blood oxygenation, the focus needs to be on expanding the airway area in the plane of the free edge of the epiglottis. In short, PSG and upper airway 3D-CT need to be carefully analyzed before surgery to provide patients with more effective and appropriate treatment options.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDisclosure statement\u003c/h2\u003e\n\u003cp\u003eNo potential conflict of interest was reported by the author(s)\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eB,Z,D,R,W,W,S,S and Q all co-authored the manuscript of the main text, and all authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eThe authors sincerely thank all the teachers who have made important contributions to the publication of this article.\u003c/p\u003e\n\u003ch2\u003eEthical approval:\u003c/h2\u003e\n\u003cp\u003eAll codes of practice and standards involved in this study were in accordance with the Declaration of Helsinki, and all studies were approved by the Ethics Committee of our hospital.\u003c/p\u003e\n\u003ch2\u003eAgree to publish:\u003c/h2\u003e\n\u003cp\u003eAll researchers involved in this paper gave their consent for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGottlieb DJ, Punjabi NM. Diagnosis and Management of Obstructive Sleep Apnea: A Review. JAMA. 2020;323(14):1389\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoren A, Groselj LD, Fajdiga I. CT comparison of primary snoring and obstructive sleep apnea syndrome: role of pharyngeal narrowing ratio and soft palate-tongue contact in awake patient. Eur Arch Otorhinolaryngol. 2009;266(5):727\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarkun LC, Sampat A. Clinician-Focused Overview and Developments in Polysomnography. Curr Sleep Med Rep. 2020;6(4):309\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerry RB, Brooks R, Gamaldo C, et al. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med. 2017;13(5):665\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeiberg AS, Silverman PM, Sessions RB, et al. 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Acta Otolaryngol. 2013;133(5):504\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eDefinition of airway parameters\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSymbol\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eDefinition\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnit\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUED\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eDistance from uvula to epiglottis\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ecm\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUD\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUvula diameter\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ecm\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSPL\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSoft palate length\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ecm\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSPD\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSoft palate diameter\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ecm\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePWD\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eposterior pharyngeal wall thickness\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ecm\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHPA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHard palate horizontal airway area\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ecm\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUvula apex horizontal airway area\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ecm\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFree edge of epiglottis horizontal airway area\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ecm\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHA\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eHyoid horizontal airway area\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ecm\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eBaseline demographic and clinical characteristics\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEpidemiology\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003echaracteristics\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eGender (N)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale:71\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eFemal: 7\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e36.31\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBMI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e27.65\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSeverity of OSAHS (N)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eMild:11\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eModerate:10\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eHeavy:57\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUpper airway parameters\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUvula diameter\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.89\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSoft palate length\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.17\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSoft palate diameter\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.88\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePosterior pharyngeal wall thickness\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.90\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHard palate horizontal airway area\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.53\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eCorrelation coefficients of PSG and 3D-CT, *\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003ep\u003c/span\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003er\u003c/span\u003e\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUED\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eUD\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eSPL\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eSPD\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003ePWD\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eHPA\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003eUA\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003eEA\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003eHA\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.015\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.141\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.142\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.359*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.036\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.203\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.040\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.046\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAHI (/h)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.004\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.026\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.142\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.258*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.047\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.049\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.030\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.093\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.007\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMSaO2 (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.003\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.075\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e-0.330*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.117\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.172\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.180\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.005\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.113\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.003\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLSaO2 (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.068\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.132\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.213\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.096\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.111\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.246\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.120\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.266*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cdiv class=\"SimplePara\"\u003e-0.015\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCT90(%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.021\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.096\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.271*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.269*\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.284\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.168\u003c/div\u003e 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"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Obstructive sleep apnea hypopnea syndrome, Polysomnography, Upper airway","lastPublishedDoi":"10.21203/rs.3.rs-4569181/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4569181/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe relationship between polysomnography (PSG) and three-dimensional computed tomography (3D-CT) hasn't been well investigated in Obstructive sleep apnea/hypopnea syndrome (OSAHS) .\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eBy analyzing PSG and 3D-CT, we obtain anatomical factors that affect the severity of OSAHS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e78 OSAHS patients were retrospectively analyzed who were admitted to the First Affiliated Hospital of University of Science and Technology of China from January 1, 2022 to November 1, 2023. All of them had completed PSG and upper airway 3D-CT. The correlation between PSG and 3D-CT parameters was analyzed in these OSAHS patients.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study showed that body mass index (BMI) was significantly correlated with the diameter of soft palate (r\u0026thinsp;=\u0026thinsp;0.359, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Apnea-hypopnea index (AHI) was significantly correlated with soft palate diameter (r\u0026thinsp;=\u0026thinsp;0.258, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Mean blood oxygen saturation (MSaO2%) was significantly correlated with the length of soft palate (r= -0.330, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The lowest blood oxygen saturation (LSaO2%) was significantly correlated with the airway area at the level of free edge of epiglottis (r\u0026thinsp;=\u0026thinsp;0.266, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The cumulative time of oxygen saturation below 90% (CT90) was significantly correlated with the length of soft palate (r\u0026thinsp;=\u0026thinsp;0.271, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). CT90 was positively correlated with the diameter of soft palate (r\u0026thinsp;=\u0026thinsp;0.269, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Other upper airway anatomical parameters, such as distance from uvula to epiglottis (UED), uvula diameter (UD), posterior pharyngeal wall thickness (PWD), hard palate horizontal airway area (HPA), uvula apex horizontal airway area (UA), hyoid horizontal airway area (HA), were not clearly correlated with AHI and blood oxygen saturation.\u003c/p\u003e\u003ch2\u003eConclusion and significance\u003c/h2\u003e \u003cp\u003eThe severity of OSAHS is mainly affected by the diameter and length of the soft palate, and the treatment of soft palate is the key to the surgical treatment of OSAHS. In patients with low minimum blood oxygenation, the treatment should focus on expanding the airway area in the plane of the free edge of the epiglottis.\u003c/p\u003e","manuscriptTitle":"Correlation between airway size and imaging examination in OSAHS patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 20:41:14","doi":"10.21203/rs.3.rs-4569181/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a297de4d-cde0-43e6-ab53-6a57e2618fd7","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-12T13:50:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 20:41:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4569181","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4569181","identity":"rs-4569181","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}