Conclusion

Structurally, the upper airway consists of several valves (nares, mouth, soft palate, collapsible pharynx, epiglottis, and glottis) that are regulated in part by upper airway muscles. These valves allow airway closure during deglutition and phonation and regulate airway patency during respiration.

Two of the most important upper airway disorders affecting respiration are laryngeal narrowing and OSA. Laryngeal narrowing can result from laryngospasm and vocal cord paralysis. Tests of upper airway function that detect laryngeal narrowing and dysfunction include indirect laryngoscopy, fiberoptic imaging, electromyography, and flow-volume loops. The upper airway closure in the vast majority of patients with OSA occurs in the pharynx with suppression of upper airway muscle activity during sleep.

Although polysomnography is not a specific test of upper airway function, it is the accepted method to diagnose this repetitive closure of the pharyngeal airway during sleep. A plethora of techniques have been developed to assess respiratory-related upper airway structure and function, ranging from measurements of upper airway resistance to MRI. However, in general, these do not have a role in the clinical assessment of upper airway function and should be reserved for the research laboratory.

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