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• W2079894640 abstract "To the EditorIn the July 1990 issue of Chest, Shepard et al1Shepard Jr, JW Garrison M Vas W Upper airway distensibility and collapsibility in patients with obstructive sleep apnea.Chest. 1990; 98: 84-91Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar discussed cross-sectional area changes in obstructive sleep apnea (OSA) detected with computed tomography (CT). The dimensions of the upper airways have, indeed, often been evaluated in OSA, and they have also been compared with airflow resistance measurements.2Stauffer JL Zwillich CW Cadieux RJ Bixler EO Kales A Varano LA et al.Pharyngeal size and resistance in obstructive sleep apnea.Am Rev Respir Dis. 1987; 136: 623-627Crossref PubMed Scopus (65) Google ScholarIt is amazing that in upper airway obstruction (UAO) at the level of the larynx and especially of the trachea, studies correlating functional data with diameters or cross-sectional area during quiet breathing and/or forced maneuvers are almost lacking. Miller and Hyatt3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar obtained data in experimental conditions in which they made healthy subjects breathe through added resistances with internal diameters varying between 4 and 13 mm and measured the corresponding changes in PEF, FEV1, and MEF50 (Fig 1). The question is, however, to what extent these results may be applied to UAO.As a first approach to this problem, we investigated whether the relationship of functional indices in UAO was similar to that in the experimental model of Miller and Hyatt3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar (Fig 1). In 18 patients with UAO4Melissant CF Van Noord JA Van de Woestijne KP Demedts M Comparison of dynamic lung function indices during forced and quiet breathing in upper airway obstruction, asthma, and emphysema.Chest. 1990; 98: 77-83Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 5Van Noord JA Wellens W Clarysse I Cauberghs M Van de Woestijne KP Demedts M Total respiratory resistance and reactance in patients with upper airway obstruction.Chest. 1987; 92: 475-480Crossref PubMed Scopus (26) Google Scholar (11 with variable extrathoracic UAO, five with fixed UAO, and two with variable intrathoracic UAO), we measured PEF, FEV1, and MEF50 and found that the relationships were similar to those in the model of Miller and Hyatt.3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar It is, therefore, tempting to conclude that this indicates that in UAO the diameter at the level of the obstruction during forced expiration may be estimated from the superposition of the functional results on the data of Miller and Hyatt.3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google ScholarThese data stress the need for direct comparative studies of anatomic-functional correlations in UAO. The difficulty, however, is that these studies should be done during quiet breathing as well as during forced maneuvers. To the EditorIn the July 1990 issue of Chest, Shepard et al1Shepard Jr, JW Garrison M Vas W Upper airway distensibility and collapsibility in patients with obstructive sleep apnea.Chest. 1990; 98: 84-91Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar discussed cross-sectional area changes in obstructive sleep apnea (OSA) detected with computed tomography (CT). The dimensions of the upper airways have, indeed, often been evaluated in OSA, and they have also been compared with airflow resistance measurements.2Stauffer JL Zwillich CW Cadieux RJ Bixler EO Kales A Varano LA et al.Pharyngeal size and resistance in obstructive sleep apnea.Am Rev Respir Dis. 1987; 136: 623-627Crossref PubMed Scopus (65) Google ScholarIt is amazing that in upper airway obstruction (UAO) at the level of the larynx and especially of the trachea, studies correlating functional data with diameters or cross-sectional area during quiet breathing and/or forced maneuvers are almost lacking. Miller and Hyatt3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar obtained data in experimental conditions in which they made healthy subjects breathe through added resistances with internal diameters varying between 4 and 13 mm and measured the corresponding changes in PEF, FEV1, and MEF50 (Fig 1). The question is, however, to what extent these results may be applied to UAO.As a first approach to this problem, we investigated whether the relationship of functional indices in UAO was similar to that in the experimental model of Miller and Hyatt3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar (Fig 1). In 18 patients with UAO4Melissant CF Van Noord JA Van de Woestijne KP Demedts M Comparison of dynamic lung function indices during forced and quiet breathing in upper airway obstruction, asthma, and emphysema.Chest. 1990; 98: 77-83Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 5Van Noord JA Wellens W Clarysse I Cauberghs M Van de Woestijne KP Demedts M Total respiratory resistance and reactance in patients with upper airway obstruction.Chest. 1987; 92: 475-480Crossref PubMed Scopus (26) Google Scholar (11 with variable extrathoracic UAO, five with fixed UAO, and two with variable intrathoracic UAO), we measured PEF, FEV1, and MEF50 and found that the relationships were similar to those in the model of Miller and Hyatt.3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar It is, therefore, tempting to conclude that this indicates that in UAO the diameter at the level of the obstruction during forced expiration may be estimated from the superposition of the functional results on the data of Miller and Hyatt.3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google ScholarThese data stress the need for direct comparative studies of anatomic-functional correlations in UAO. The difficulty, however, is that these studies should be done during quiet breathing as well as during forced maneuvers. In the July 1990 issue of Chest, Shepard et al1Shepard Jr, JW Garrison M Vas W Upper airway distensibility and collapsibility in patients with obstructive sleep apnea.Chest. 1990; 98: 84-91Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar discussed cross-sectional area changes in obstructive sleep apnea (OSA) detected with computed tomography (CT). The dimensions of the upper airways have, indeed, often been evaluated in OSA, and they have also been compared with airflow resistance measurements.2Stauffer JL Zwillich CW Cadieux RJ Bixler EO Kales A Varano LA et al.Pharyngeal size and resistance in obstructive sleep apnea.Am Rev Respir Dis. 1987; 136: 623-627Crossref PubMed Scopus (65) Google Scholar It is amazing that in upper airway obstruction (UAO) at the level of the larynx and especially of the trachea, studies correlating functional data with diameters or cross-sectional area during quiet breathing and/or forced maneuvers are almost lacking. Miller and Hyatt3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar obtained data in experimental conditions in which they made healthy subjects breathe through added resistances with internal diameters varying between 4 and 13 mm and measured the corresponding changes in PEF, FEV1, and MEF50 (Fig 1). The question is, however, to what extent these results may be applied to UAO. As a first approach to this problem, we investigated whether the relationship of functional indices in UAO was similar to that in the experimental model of Miller and Hyatt3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar (Fig 1). In 18 patients with UAO4Melissant CF Van Noord JA Van de Woestijne KP Demedts M Comparison of dynamic lung function indices during forced and quiet breathing in upper airway obstruction, asthma, and emphysema.Chest. 1990; 98: 77-83Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 5Van Noord JA Wellens W Clarysse I Cauberghs M Van de Woestijne KP Demedts M Total respiratory resistance and reactance in patients with upper airway obstruction.Chest. 1987; 92: 475-480Crossref PubMed Scopus (26) Google Scholar (11 with variable extrathoracic UAO, five with fixed UAO, and two with variable intrathoracic UAO), we measured PEF, FEV1, and MEF50 and found that the relationships were similar to those in the model of Miller and Hyatt.3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar It is, therefore, tempting to conclude that this indicates that in UAO the diameter at the level of the obstruction during forced expiration may be estimated from the superposition of the functional results on the data of Miller and Hyatt.3Miller RD Hyatt RE Obstructing lesions of the larynx and trachea: clinical and physiological characteristics.Mayo Clin Proc. 1969; 44: 145-161PubMed Google Scholar These data stress the need for direct comparative studies of anatomic-functional correlations in UAO. The difficulty, however, is that these studies should be done during quiet breathing as well as during forced maneuvers. Upper Airway Obstruction: Anatomic-Functional RelationshipCHESTVol. 100Issue 1PreviewWe appreciate the comments of Drs Melissant and Demedts and agree with them that physiologic (spirometric) data indicating obstruction to airflow should predict the extent of anatomic narrowing. Ideally, imaging techniques should identify regions of upper airway narrowing that would correspond approximately to the orifice diameters used by Miller and Hyatt1 to produce similar decrements in the spirometric variables reflecting airflow. However, in order to obtain optimal functional-anatomic correlations, imaging must be performed under identical conditions of pressure, lung volume, and upper airway muscle activity. Full-Text PDF" @default.
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