Critical to Know Pcrit: A Review on Pharyngeal Critical Closing Pressure in Obstructive Sleep Apnea

Elahe Kazemeini; Eli Van de Perck; Marijke Dieltjens; Marc Willemen; Johan Verbraecken; Sara Op de Beeck; Olivier M Vanderveken

doi:10.3389/fneur.2022.775709

Critical to Know Pcrit: A Review on Pharyngeal Critical Closing Pressure in Obstructive Sleep Apnea

Front Neurol. 2022 Feb 22:13:775709. doi: 10.3389/fneur.2022.775709. eCollection 2022.

Authors

Elahe Kazemeini^{1

2}, Eli Van de Perck^{1

2}, Marijke Dieltjens^{1

2}, Marc Willemen³, Johan Verbraecken^{1

3

4}, Sara Op de Beeck^{1

2

3}, Olivier M Vanderveken^{1

2

3}

Affiliations

¹ Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
² Ear, Nose, Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
³ Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium.
⁴ Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium.

Abstract

It is crucial to understand the underlying pathophysiology of obstructive sleep apnea (OSA). Upper airway collapsibility is an important pathophysiological factor that affects the upper airway in OSA. The aim of the current study was to review the existing body of knowledge on the pharyngeal collapsibility in OSA. After a thorough search through Medline, PubMed, Scopus, and Web of science, the relevant articles were found and used in this study. Critical closing pressure (Pcrit) is the gold standard measure for the degree of collapsibility of the pharyngeal airway. Various physiological factors and treatments affect upper airway collapsibility. Recently, it has been shown that the baseline value of Pcrit is helpful in the upfront selection of therapy options. The standard techniques to measure Pcrit are labor-intensive and time-consuming. Therefore, despite the importance of Pcrit, it is not routinely measured in clinical practice. New emerging surrogates, such as finite element (FE) modeling or the use of peak inspiratory flow measurements during a routine overnight polysomnography, may enable clinicians to have an estimate of the pharyngeal collapsibility. However, validation of these techniques is needed.

Keywords: OSA; Pcrit; collapsibility; endotyping; upper airway.

Publication types

Review