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. 2010 Jun;11(6):540-4.
doi: 10.1016/j.sleep.2010.01.008. Epub 2010 May 13.

MRI of the Pharynx in Ischemic Stroke Patients With and Without Obstructive Sleep Apnea

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Free PMC article

MRI of the Pharynx in Ischemic Stroke Patients With and Without Obstructive Sleep Apnea

Devin L Brown et al. Sleep Med. .
Free PMC article

Abstract

Background: Obstructive sleep apnea (OSA) is common after stroke and associated with poor stroke outcomes. Whether OSA after acute stroke is caused by anatomic, physiologic, or both etiologies has not been studied. We therefore used brain magnetic resonance imaging (MRI) scans to assess oropharyngeal anatomy in stroke patients with and without OSA.

Methods: Patients within 7 days of ischemic stroke underwent nocturnal polysomnography. Sagittal T1-weighted MRI performed for clinical purposes was used to measure retropalatal distance, soft palatal length, soft palatal thickness, retroglossal space, and tongue length. Nasopharyngeal area and high retropharyngeal area were measured from axial T2-weighted images, and lateral pharyngeal wall thickness from coronal T1-weighted images.

Results: Among 27 subjects, 18 (67%) had OSA (apnea/hypopnea index (AHI)5). Demographics, vascular risk factors, and stroke severity were similar in the two groups. Median retropalatal distance was shorter in subjects with OSA (Wilcoxon rank-sum test, p=0.03). Shorter retropalatal distance was associated with higher AHI (linear regression, p=0.04). None of the other morphological characteristics differed.

Conclusions: Anatomic difference between awake acute stroke patients with and without OSA shows that the sleep disorder cannot be attributed solely to sleep, sleeping position, or changes in neuromuscular control that are specific to the sleep state.

Figures

Figure 1
Figure 1
MRI measurements: (A) Palatal length on sagittal T1-weighted image. (B) Palatal thickness (A-B) and retropalatal distance (C-D) on a sagittal T1-weighted image. (C) Tongue length (A-B) and the retroglossal space (C-D) on sagittal T1-weighted image. (D) Lateral pharyngeal wall thickness on a coronal T1-weighted image. (E) Cross sectional area of high retropharyngeal region on axial T2-weighted image. (F) Cross-sectional area of nasopharynx on axial T2-weighted image.
Figure 2
Figure 2
Scatter plot of apnea-hypopnea index (Y-axis) and retropalatal distance (X-axis).
Figure 3
Figure 3
Plot of receiver operating characteristic curve: discrimination of retropalatal distance for obstructive sleep apnea diagnosis.

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