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Electron microscopy study of peripheral nerves in the uvulae of snorers and obstructive sleep apnoea patients

Published online by Cambridge University Press:  13 June 2008

A Bassiouny ,
S Nasr ,
M Mashaly ,
E Ayad ,
M Qotb  and
A Atef
A Bassiouny
Affiliation:
Department of Otolaryngology, Cairo University, Egypt
S Nasr
Affiliation:
Department of Biomedical Sciences, Cairo University, Egypt
M Mashaly
Affiliation:
Department of Otolaryngology, Cairo University, Egypt
E Ayad
Affiliation:
Department of Pathology, Cairo University, Egypt
M Qotb
Affiliation:
Department of Otolaryngology, Cairo University, Egypt
A Atef*
Affiliation:
Department of Otolaryngology, Cairo University, Egypt
*
Address for correspondence: Dr Ahmed Atef, 7 el Shaheed Mahmoud Afifi St, Almaza, Cairo, Egypt11341. E-mail: amratef@dr.com
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Abstract

Hypothesis:

The pathophysiology of snoring and obstructive sleep apnoea is still unclear. Two theories are proposed. The first is the obstructive theory, which postulates palatopharyngeal muscle hypertrophy leading to airway narrowing; there is no neural role. The second is the neurogenic theory, which postulates neural degeneration due to vibratory stretch trauma, leading to muscle atrophy and collapse. As identification of nerve fibres in the uvula and palate is difficult and time-consuming, all previous studies aiming to differentiate between these two theories have been based on indirect observation of the muscles, rather than direct study of the nerves.

Methods:

We conducted a prospective study to directly observe and study nerve fibres in uvular specimens from 10 cases of obstructive sleep apnoea, compared with specimens from 10 cases of simple snoring, using transmission electron microscopy. Five autopsy cases served as controls.

Results:

Obstructive sleep apnoea was associated with definite degenerative changes in myelinated and unmyelinated nerve endings. These degenerative changes were present to a lesser degree and in a smaller proportion of cases of simple snoring.

Conclusion:

The events postulated by the neurogenic theory of obstructive sleep apnoea appear to play an important role in the pathophysiology of snoring and obstructive sleep apnoea.

Keywords

Sleep Apnoea SyndromesSnoringPalateUvulaElectron Microscopy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 2 , February 2009 , pp. 203 - 207
Copyright
Copyright © JLO (1984) Limited 2008

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References

1Metternich, FU, Brusis, T, Koebke, J, Wenzel, S. Studies of the histomorphology and function of the uvula. Laryngorhinootologie 2000;79:465–70 [in English]CrossRefGoogle ScholarPubMed
2Goode, LR. Sleep disorders. In: Cummings, CW, ed. Otolaryngology – Head and Neck Surgery. Philadelphia, USA: Mosby, 1986;2:1449–50Google Scholar
3Stauffer, JL, Buick, MK, Bixler, EO, Sharkey, FE, Abt, AB, Manders, EK et al. Morphology of the uvula in obstructive sleep apnea. Am Rev Respir Dis 1989;140:724–8CrossRefGoogle ScholarPubMed
4Woodson, T, Garancis, J, Toohill, R. Histopathologic changes in snoring and obstructive sleep apnea syndrome. Laryngoscope 1991;101:1318–22CrossRefGoogle ScholarPubMed
5Edström, L, Larsson, H, Larsson, L. Neurogenic effects on the palatopharyngeal muscle in patients with obstructive sleep apnoea: a muscle biopsy study. J Neurol Neurosurg Psych 1992;55:916–20Google Scholar
6Swift, AC, Goulding, H, Eldder, J, Haqqani, MT. A histopathological comparison of uvula between snorers and non snorers. Clin Otolaryngol 1995;20:517–21Google Scholar
7Yu, X, Liu, D, Zhang, S. Pathological changes of the palatopharyngeal soft tissue in obstructive sleep apnea syndrome. Zhonghua 1998;33:309–12 [in English]Google Scholar
8Friberg, D, Gazelius, B, Hökfelt, T, C-Nordlander, B. Abnormal afferent nerve endings in the soft palatal mucosa of sleep apnoics and habitual snorers. Regulatory Peptides 1997;71:29–36Google Scholar
9Schafer, J . How can one recognize a velum snorer? Laryngorhinootologie 1989;68:290–4Google ScholarPubMed
10Takeuchi, T, Futatsuka, M, Imanishi, H. Pathological changes observed in the finger biopsy of patients with vibration-induced white finger. Scand J Work Envir Health 1986;12:280–3CrossRefGoogle ScholarPubMed