Histo-pathological study of the oropharynx in snoring and obstructive sleep apnea patients

Obstructive sleep apnea [OSA] is characterized by repetitive episodes of upper airway occlusion during sleep. The purpose of this work is to study the histopathological alterations of the oropharyngeal tissues in patients with snoring and OSA. The study was carried out on two groups of patients, selected from ENT outpatients clinics of Al-Azhar University hospitals from November 2001 to June 2002. The first group, includes 30 patients, 10 snorers and 20 with OSA. They underwent uvulopalatopharyngoplasty [UPPP] and the pharyngeal specimens were taken from the distal soft palate [uvula, anterior and posterior pillars]. The second group, [control] includes 7 persons with chronic tonsillitis and underwent tonsillectomy and the control pharyngeal specimens were taken from very small parts of the anterior and posterior tonsillar pillars excised during tonsillectomy. The study revealed that obstructive sleep apnea patients were commonly obese, male, and older than the other patients. Histopathological examination showed extensive edema in the lamina propria of the distal soft palate in snorers and OSA patients and also, extensive fatty infiltration in these patients which may play a role in etiopathogenesis of OSA. There was a significant correlation between the degree of pharyngeal fatty infiltration and, the apnea index and the neck circumference but no, significant correlation with the body mass index was found. Vascular engorgement, interstitial haemorrhage, chronic inflammatory cell infiltration, and glandular hyperplasia were observed in a portion of patients with snoring and OSA, and in some controls, also lymphangectasia was found in 3 obese patients with severe OSA. So, these pathologic changes may reflect the sequel of airway obstruction rather than its cause