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Palatal Sensory Function Worsens in Untreated Snorers but not in CPAP-Treated Patients With Sleep Apnea, Indicating Vibration-Induced Nervous Lesions
Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.ORCID iD: 0000-0003-1884-5696
Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden.
2020 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 157, no 5, p. 1296-1303Article in journal (Refereed) Published
Abstract [en]

Background: Signs of both motor and sensory nervous lesions have previously been shown in the upper airway of patients with OSA and habitual snorers. Snoring per se may damage all upper airway neurons over time, thereby causing progression to manifest sleep apnea. To test this hypothesis, nonsnoring subjects, untreated snorers, and CPAP-treated patients underwent repeated sensory testing of the soft palate in a prospective long-term study. Methods: Cold detection threshold (CDT) testing at the soft palate and lip with a thermode and nocturnal respiratory recordings were performed in 2008 to 2009 with retesting 6 to 7 years later. Results: In 25 untreated snorers, palatal CDT worsened from a median (25th-75th percentile range) 4.2°C (3.2-5.9) to 11.0°C (7.0-17.4) (P < .001). The apnea-hypopnea index increased from a median 7.0 to 14.0 events/h (P < .05). There was no significant correlation between changes in CDT and the apnea-hypopnea index. In 21 nonsnoring control subjects, palatal CDT increased from a median 3.2°C to 5.6°C (P < .005). In 19 CPAP-treated patients, palatal CDT did not significantly change; eight patients had improved values. CDTs worsened significantly more in the snorers group than in the control subjects (P < .05) and the CPAP-treated patients (P < .001). There was no significant difference between control subjects and CPAP-treated patients. Conclusions: CDT worsened considerably over time in untreated snorers, significantly more than in nonsnoring control subjects and CPAP-treated patients. Untreated snorers therefore risk developing poor sensitivity in the upper airway. In contrast, efficient treatment of OSA seems to protect the sensory innervation, as the CPAP-treated group maintained their sensitivity to cold and, in some cases, the sensitivity even improved. 

Place, publisher, year, edition, pages
Elsevier, 2020. Vol. 157, no 5, p. 1296-1303
Keywords [en]
cold detection thresholds, palatal nervous lesions, progression, sensory nervous lesions, sleep apnea, adult, aged, apnea hypopnea index, Article, body mass, calculation, cold detection threshold test, cold sensitivity, controlled study, female, function test, human, lip, major clinical study, male, oxygen desaturation, positive end expiratory pressure, priority journal, prospective study, sex difference, sleep disordered breathing, soft palate, very elderly
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-48584DOI: 10.1016/j.chest.2020.01.032ISI: 000532715300043PubMedID: 32059960Scopus ID: 2-s2.0-85083507636OAI: oai:DiVA.org:hj-48584DiVA, id: diva2:1433309
Funder
Swedish Heart Lung FoundationMedical Research Council of Southeast Sweden (FORSS)Available from: 2020-05-29 Created: 2020-05-29 Last updated: 2020-05-29Bibliographically approved

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