Title:Objective Evaluation of Oral and Pharyngeal Areas in Autopsy Cases of
Obstructive Sleep Apnea Syndrome via Postmortem CT
Volume: 20
Author(s): Akiko Takeuchi, Hideki Hyodoh, Shigeki Jin, Satoshi Tanaka, Manabu Murakami, Kazuyuki Minowa and Kotaro Matoba*
Affiliation:
- Department of Forensic Medicine, Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
Keywords:
Postmortem computed tomography, Three-dimensional computed tomography, Oropharynx, Air space volume, Obstructive sleep apnea syndrome, Oral volume metric, Postmortem imaging.
Abstract:
Background:
Obstructive sleep apnea syndrome (OSAS) can cause sudden death during sleep. Previous findings have suggested that OSAS development is
related to maxillofacial morphology. Evaluation of facial morphology can determine the risk of developing the disease, and establishing an
objective method to assess the underlying etiology of OSAS-related death would be advantageous.
Objective:
The objective of this study is to determine the key features of obstructive sleep apnea syndrome (OSAS) using postmortem oral and pharyngeal
computed tomography (CT).
Methods:
We retrospectively assessed autopsy cases of patients with (n=25) and without (n=25) OSAS-related death. We used oral and pharyngeal CT
images to compare the oral and pharyngeal cavity volume (OPCV), oral and pharyngeal soft tissue volume (OPSV), oral and pharyngeal air space
volume (OPAV), and OPAV to OPCV ratio (%air). Receiver operating curve (ROC) analysis was used to determine the accuracy of OSAS
prediction. We assessed participants with body mass index (BMI) values within the normal range.
Results:
Among the 50 subjects, we observed significant between-group differences in OPSV, OPAV, and % air, whereas there were significant betweengroup
differences in OPSV and %air among 28 subjects with normal BMI values. Both comparisons suggested that OSAS-related death was
associated with low %air and high OPSV values.
Conclusion:
The % air and OPSV are useful for assessing postmortem oropharyngeal CT images. OSAS-related sudden death is likely when %air and OPSV
values are ≤20.1% and ≥127.2 ml, respectively. Among those with normal BMI values, % air and OPSV values of ≤22.8% and ≥111.5 ml,
respectively, predict OSAS-related sudden death.
