Skip to main content
AAO-HNSF 2023 Annual Meeting & OTO Experience Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back
Rate ePoster

Sleep Medicine

(291) Laryngeal Hyposensitivity in Patients with Obstructive Sleep Apnea

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Jacquelyn K. Callander, MD

    Resident Physician
    University of California - San Francisco
    San Francisco, California, United States

    • Co-Author(s)

  • Nazineen Kandahari, MS

    Resident Physician
    University of California San Francisco
    Chapel Hill, North Carolina, United States

  • MS

    Madeleine Strohl, MD

    Assistant Professor
    University of Louisville, USA

  • SC

    Steven W. Cheung, MD

    Professor
    University of California San Francisco
    San Francisco, California, USA

    • Senior Author(s)

  • Jolie L. Chang, MD

    Associate Professor, Otolaryngology HNS
    University of California San Francisco
    San Francisco, CA, United States

Disclosure(s):
Jacquelyn K. Callander, MD: No relevant relationships to disclose.
Nazineen Kandahari, MS: No relevant relationships to disclose.


Introduction: Obstructive sleep apnea (OSA) is associated with recurrent upper airway collapse during sleep, due to reduced upper airway neuromuscular tone. Impaired laryngopharyngeal sensation has been implicated in OSA and may play an important pathophysiological role. Laryngopharyngeal sensory stimulation triggers the laryngeal adductor reflex (LAR), an involuntary airway protective action. We evaluated sensory function in OSA by examining the LAR response rate and motoric profile following tactile stimulation using Cheung-Bearelly monofilament aesthesiometers.

Methods: Laryngeal sensation testing was performed in awake adults with OSA during endoscopy by stimulating the medial aryepiglottic (AE) fold or arytenoid using 5-0 and 4-0 nylon 30 mm monofilaments. Video analysis by two independent reviewers evaluated presence of a full LAR response, latency to vocal fold adduction, and duration of vocal fold closure. Analyses of response rates based on total stimuli and subject level events were performed. Responder status was defined as presence of LAR in ≥ 50% of satisfactory stimuli delivered. Published normative studies of LAR rates and temporal metrics by study investigators were used for comparisons.

Results: Nineteen subjects (21% female) with median age 58 years (IQR 48-69) and median AHI of 26.2 events/hour (IQR 15.6-45) were tested with 125 satisfactory stimuli for LAR response analysis. The OSA LAR response rate was 28% for 5-0 monofilament and 45% for 4-0 monofilament stimuli. Compared to normative data LAR response rates (90% for 5-0; 88% for 4-0), the lower OSA response rates were statistically significant (p= 0.0007, p< 0.001). At the subject level, only 42% (n=8) of OSA patients were responders to 4-0 monofilament stimulation. The mean latency to vocal fold closure was 129.0ms (SD 61.9) and duration of vocal fold closure was 121.9ms (SD 50.7).

Conclusions: LAR response rates to tactile stimuli delivered to the AE fold or arytenoid in OSA patients were significantly reduced compared to normative data, demonstrating OSA is associated with significant laryngeal hyposensitivity.