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Updated: May 16, 2026
Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Three-dimensional upper airway phenotyping and OSA severity: a CT-based study
JiaYue Wang1, Tao Li1, Su Hua Sun1
1Department of Otorhinolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, China.
Background:
Obstructive sleep apnea (OSA) involves recurrent upper airway collapse. While anatomical factors are key, the correlation between three-dimensional (3D) upper airway parameters and OSA severity remains inconsistent, limiting personalized treatment.
Materials And Methods:
69 OSA patients underwent polysomnography and computed tomography. The upper airway was segmented into nasopharynx, retropalatal oropharynx, and retroglossal oropharynx. Parameters, including soft palate length, hyoid-to-mandibular plane distance, subregion volumes, minimum cross-sectional area (MIN-CSA), and the ratio of total volume to MIN-CSA (TV-NP-OP/MIN-CSA), were measured. Spearman's correlation, receiver operating characteristic (ROC) analysis, and logistic regression assessed associations with the apnea-hypopnea index (AHI). Bonferroni correction was applied (p < 0.005).
Results:
AHI significantly correlated with MIN-CSA (r = -0.478), anteroposterior diameter at MIN-CSA (AP-MIN) (r = -0.399), lateral diameter at MIN-CSA (Lat-MIN) (r = -0.323), and TV-NP-OP/MIN-CSA (r = 0.473) (all p < 0.001). TV-NP-OP/MIN-CSA ("Anatomical Risk Index") showed good diagnostic performance for moderate-to-severe (area under the curve (AUC) = 0.779) and severe OSA (AUC = 0.789), and was an independent predictor across body mass index (BMI) subgroups. No volumetric parameters correlated with AHI. Reliability was excellent (intraclass correlation coefficients (ICCs) > 0.90).
Conclusion:
TV-NP-OP/MIN-CSA is a robust 3D anatomical parameter associated with OSA severity, offering a potential imaging biomarker for risk stratification.
Key Points:
Question What is the most relevant 3D anatomical parameter derived from CT imaging that correlates with OSA severity, and can it serve as a reliable imaging biomarker? Findings The ratio of TV-NP-OP/MIN-CSA was strongly correlated with OSA severity (r = 0.473, p < 0.001) and served as an independent predictor across all BMI subgroups, with excellent measurement reliability. Clinical relevance This CT-based "Anatomical Risk Index" can help identify high-risk OSA phenotypes, guide personalized treatment planning, and improve risk stratification without requiring additional imaging, thereby optimizing therapeutic outcomes.
