{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T03:51:35Z","timestamp":1776743495746,"version":"3.51.2"},"reference-count":36,"publisher":"FapUNIFESP (SciELO)","issue":"4","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. bras. pneumol."],"abstract":"<jats:p>ABSTRACT  Objective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position.  Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states.  Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p &lt; 0.001) and in the control group (p &lt; 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p &lt; 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects.  Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.<\/jats:p>","DOI":"10.1590\/1806-3713\/e20180264","type":"journal-article","created":{"date-parts":[[2019,8,16]],"date-time":"2019-08-16T17:56:39Z","timestamp":1565978199000},"source":"Crossref","is-referenced-by-count":16,"title":["State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea"],"prefix":"10.1590","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0789-1681","authenticated-orcid":false,"given":"Ula Lindoso","family":"Passos","sequence":"first","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6764-165X","authenticated-orcid":false,"given":"Pedro Rodrigues","family":"Genta","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3190-8797","authenticated-orcid":false,"given":"Bianca Fernandes","family":"Marcondes","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7011-7373","authenticated-orcid":false,"given":"Geraldo","family":"Lorenzi-Filho","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6514-3825","authenticated-orcid":false,"given":"Eloisa Maria Mello Santiago","family":"Gebrim","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2019]]},"reference":[{"issue":"9918","key":"ref1","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/S0140-6736(13)60734-5","article-title":"Adult obstructive sleep apnoea","volume":"383","author":"Jordan AS","year":"2014","journal-title":"Lancet"},{"issue":"5","key":"ref2","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.sleep.2009.10.005","article-title":"Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study","volume":"11","author":"Tufik S","year":"2010","journal-title":"Sleep Med"},{"issue":"9464","key":"ref3","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/S0140-6736(05)71141-7","article-title":"Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure an observational study","volume":"365","author":"Marin JM","year":"2005","journal-title":"Lancet"},{"issue":"6","key":"ref4","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1164\/ajrccm.153.6.8665050","article-title":"Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls","volume":"153","author":"Mezzanotte WS","year":"1996","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"ref5","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1378\/chest.111.1.154","article-title":"Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers","volume":"111","author":"Nelson S","year":"1997","journal-title":"Chest"},{"issue":"1","key":"ref6","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1378\/chest.124.1.212","article-title":"Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome","volume":"124","author":"Yu X","year":"2003","journal-title":"Chest"},{"issue":"6","key":"ref7","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.sleep.2005.03.007","article-title":"The anatomic basis for the acquisition of speech and obstructive sleep apnea evidence from cephalometric analysis supports The Great Leap Forward hypothesis","volume":"6","author":"Davidson TM","year":"2005","journal-title":"Sleep Med"},{"issue":"3","key":"ref8","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1378\/chest.15-0638","article-title":"Different Craniofacial Characteristics Predict Upper Airway Collapsibility in Japanese-Brazilian and White Men","volume":"149","author":"Schorr F","year":"2016","journal-title":"Chest"},{"issue":"10","key":"ref9","first-page":"2624","article-title":"Evaluation of the upper airway cross-sectional area changes in different degrees of severity of obstructive sleep apnea syndrome cephalometric and dynamic CT study","volume":"26","author":"Yucel A","year":"2005","journal-title":"AJNR Am J Neuroradiol"},{"issue":"9","key":"ref10","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1136\/thx.2010.151613","article-title":"Effect of weight loss on upper airway size and facial fat in men with obstructive sleep apnoea","volume":"66","author":"Sutherland K","year":"2011","journal-title":"Thorax"},{"issue":"10","key":"ref11","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.5665\/sleep.4078","article-title":"Upper airway collapsibility is associated with obesity and hyoid position","volume":"37","author":"Genta PR","year":"2014","journal-title":"Sleep"},{"issue":"7","key":"ref12","first-page":"1205","article-title":"Fluoroscopic MR of the pharynx in patients with obstructive sleep apnea","volume":"19","author":"J\u00e4ger L","year":"1998","journal-title":"AJNR Am J Neuroradiol"},{"issue":"2","key":"ref13","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1183\/09031936.00119210","article-title":"Identification of craniofacial risk factors for obstructive sleep apnoea using three-dimensional MRI","volume":"38","author":"Chi L","year":"2011","journal-title":"Eur Respir J"},{"issue":"4","key":"ref14","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/sleep\/34.4.469","article-title":"Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea","volume":"34","author":"Sutherland K","year":"2011","journal-title":"Sleep"},{"issue":"5","key":"ref15","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1164\/rccm.200208-866OC","article-title":"Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging","volume":"168","author":"Schwab R","year":"2003","journal-title":"Am J Respir Crit Care Med"},{"issue":"5","key":"ref16","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1164\/ajrccm.152.5.7582313","article-title":"Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing Significance of the lateral pharyngeal walls","volume":"152","author":"Schwab RJ","year":"1995","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"ref17","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/s11325-014-0989-6","article-title":"European position paper on drug-induced sedation endoscopy (DISE)","volume":"18","author":"De Vito A","year":"2014","journal-title":"Sleep Breath"},{"issue":"4","key":"ref18","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1164\/ajrccm.158.4.9712063","article-title":"State-related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects","volume":"158","author":"Trudo FJ","year":"1998","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"ref19","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1148\/radiology.201.2.8888230","article-title":"Sleep apnea syndrome comparison of MR imaging of the oropharynx with physiologic indexes","volume":"201","author":"Suto Y","year":"1996","journal-title":"Radiology"},{"issue":"6","key":"ref20","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1002\/lary.25085","article-title":"Sleep magnetic resonance imaging with electroencephalogram in obstructive sleep apnea syndrome","volume":"125","author":"Kavcic P","year":"2015","journal-title":"Laryngoscope"},{"issue":"6","key":"ref21","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1002\/lary.21810","article-title":"Sleep magnetic resonance imaging dynamic characteristics of the airway during sleep in obstructive sleep apnea syndrome","volume":"121","author":"Barrera JE","year":"2011","journal-title":"Laryngoscope"},{"issue":"6","key":"ref22","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.2214\/ajr.148.6.1069","article-title":"Cine CT in obstructive sleep apnea","volume":"148","author":"Stein MG","year":"1987","journal-title":"AJR Am J Roentgenol"},{"issue":"4","key":"ref23","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1080\/08869634.2001.11746176","article-title":"Variable site of oropharyngeal narrowing and regional variations of oropharyngeal collapsibility among snoring patients during wakefulness and sleep","volume":"19","author":"Choi JK","year":"2001","journal-title":"Cranio"},{"issue":"268","key":"ref24","first-page":"719","article-title":"Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea","volume":"72","author":"Horner RL","year":"1989","journal-title":"Q J Med"},{"issue":"5","key":"ref25","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1164\/rccm.200503-340OC","article-title":"Early signs of atherosclerosis in obstructive sleep apnea","volume":"172","author":"Drager LF","year":"2005","journal-title":"Am J Respir Crit Care Med"},{"key":"ref26","series-title":"The AASM manual for the scoring of sleep and associated events, rules. Terminology and technical specifications","author":"Iber C","year":"2007","edition":"1"},{"issue":"5","key":"ref27","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1093\/sleep\/27.5.942","article-title":"Lateral pharyngoplasty versus uvulopalatopharyngoplasty a clinical, polysomnographic and computed tomography measurement comparison","volume":"27","author":"Cahali MB","year":"2004","journal-title":"Sleep"},{"issue":"3","key":"ref28","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/jsr.12008","article-title":"Sleep endoscopy with simulation bite for prediction of oral appliance treatment outcome","volume":"22","author":"Vroegop AV","year":"2013","journal-title":"J Sleep Res"},{"issue":"12","key":"ref29","doi-asserted-by":"crossref","first-page":"2710","DOI":"10.1002\/lary.22369","article-title":"One hundred consecutive patients undergoing drug-induced sleep endoscopy results and evaluation","volume":"121","author":"Ravesloot MJ","year":"2011","journal-title":"Laryngoscope"},{"issue":"8","key":"ref30","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1007\/s00405-011-1633-8","article-title":"Drug-induced sleep endoscopy the VOTE classification","volume":"268","author":"Kezirian EJ","year":"2011","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"6","key":"ref31","doi-asserted-by":"crossref","first-page":"2257","DOI":"10.1152\/japplphysiol.00402.2003","article-title":"Dynamic interaction between the tongue and soft palate during obstructive apnea in anesthetized patients with sleep-disordered breathing","volume":"95","author":"Isono S","year":"2003","journal-title":"J Appl Physiol (1985)"},{"issue":"48","key":"ref32","first-page":"3389","article-title":"Comparative study of determining the sites of airway obstruction in obstructive sleep apnea hypopnea syndrome between real-time CT scans and laryngofiberscope technology [Article in Chinese] Zhonghua Yi Xue Za","volume":"92","author":"Yan ZQ","year":"2012","journal-title":"Zhi"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.resp.2018.06.008","article-title":"Retropalatal and retroglossal airway compliance in patients with obstructive sleep apnea","volume":"258","author":"Marques M","year":"2018","journal-title":"Respir Physiol Neurobiol"},{"issue":"4","key":"ref34","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1164\/ajrccm.154.4.8887615","article-title":"Upper airway and soft tissue structural changes induced by CPAP in normal subjects","volume":"154","author":"Schwab RJ","year":"1996","journal-title":"Am J Respir Crit Care Med"},{"issue":"8","key":"ref35","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1136\/thx.2009.131094","article-title":"The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea","volume":"65","author":"Chan AS","year":"2010","journal-title":"Thorax"},{"issue":"6","key":"ref36","doi-asserted-by":"crossref","first-page":"2132","DOI":"10.1152\/jappl.1995.79.6.2132","article-title":"Advancement of the mandible improves velopharyngeal airway patency","volume":"79","author":"Isono S","year":"1995","journal-title":"J Appl Physiol (1985)"}],"container-title":["Jornal Brasileiro de Pneumologia"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/jbpneu\/v45n4\/1806-3713-jbpneu-45-04-e20180264.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,2,11]],"date-time":"2020-02-11T19:31:03Z","timestamp":1581449463000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S1806-37132019000400207&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019]]}},"alternative-id":["S1806-37132019000400207"],"URL":"https:\/\/doi.org\/10.1590\/1806-3713\/e20180264","relation":{},"ISSN":["1806-3756","1806-3713"],"issn-type":[{"value":"1806-3756","type":"electronic"},{"value":"1806-3713","type":"print"}],"subject":[],"published":{"date-parts":[[2019]]},"article-number":"e20180264"}}