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A simple procedure for measuring pharyngeal sensitivity: a contribution to the diagnosis of sleep apnoea

Laboratoire du sommeil et Laboratoire HP2 (INSERM ESPRI EA3745), Centre Hospitalier Universitaire, BP 217, 38043 Grenoble Cedex 09, France

Correspondence to:
Correspondence to:
Dr M Dematteis
Laboratoire HP2 (Hypoxie-PhysioPathologies), Faculté de Médecine de Grenoble, Domaine de La Merci, 38706 La Tronche Cedex, France; maurice.dematteis{at}ujf-grenoble.fr

Background: Patients with severe apnoea may have an impaired pharyngeal dilating reflex related to decreased pharyngeal sensitivity. The accuracy of a simple new procedure to measure pharyngeal sensitivity and to diagnose sleep disordered breathing (SDB) was investigated.

Methods: Pharyngeal disappearance and appearance sensory perception thresholds were measured by delivering different airflow rates on the soft palate using an intraoral device in 17 controls and 50 patients suffering from SDB evaluated by overnight polygraphy. The procedure was performed before (baseline) and after three successive administrations of a topical anaesthetic to sensitise the pharyngeal sensory impairment. Pharyngeal sensitivity was then evaluated according to SDB severity. SDB was classified as mild, moderate or severe according to the relative proportion of obstructive apnoeas-hypopnoeas and the amount of desaturation.

Results: Patients had higher baseline disappearance and appearance sensory thresholds than controls (mean (SD) 0.62 (0.44) v 0.26 (0.06) l/min and 0.85 (0.40) v 0.40 (0.19) l/min, p<0.001, respectively). Such differences were enhanced by topical anaesthesia. Impairment of pharyngeal sensitivity and the number of patients with impaired sensitivity increased from the least to the most severe SDB group as indicated by the test sensitivity for a respiratory disturbance index of >20/hour (50%, 73.7% and 88.5% in the mild, moderate, and severely affected groups, respectively).

Conclusions: This simple and safe procedure showed that impairment of pharyngeal sensitivity is correlated with severity of SDB. Using this test in routine clinical practice may simplify the diagnosis of sleep apnoea, particularly for the most severe patients.

Abbreviations: AHI, apnoea/hypopnoea index; BMI, body mass index; PDM, pharyngeal dilator muscles; RDI, respiratory disturbance index; SDB, sleep disordered breathing

Keywords: sleep disordered breathing; sleep apnoea; pharyngeal sensitivity; pharyngeal reflex; upper airway collapsibility; diagnosis

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