What is the role of the larynx in adult obstructive sleep apnea?

OBJECTIVES/HYPOTHESIS To examine the current body of literature supporting the role of the larynx in adult obstructive sleep apnea (OSA). DATA SOURCES PubMed. METHODS PubMed search using medical subject headings "larynx" and "obstructive sleep apnea." Original articles in English related to adult patients were initially included, and the bibliographies of pertinent articles were hand-searched for additional articles. RESULTS A total of 17 articles were included in the review in the following subgroups: neuromuscular role of larynx (n = 3), anatomic contribution of larynx to OSA (n = 7), and special populations (n = 7). The sensory component of the superior laryngeal nerve plays a critical role in airway patency during sleep, and patients with OSA have increased endolaryngeal sensory thresholds compared to controls. Primary epiglottic obstruction in the hypopharynx represents 15% of patients with OSA unable to tolerate continuous positive airway pressure. Head and neck cancer and multiple system atrophy are two entities with high rates of OSA due in part to laryngeal abnormalities. CONCLUSIONS The endolarynx warrants consideration in the pathophysiology of OSA, particularly as it relates to sensory dysfunction and epiglottic obstruction. Patients with head and neck cancer of the laryngopharynx are at significant risk of OSA. Further research is needed to better understand and heighten awareness of the intimate role that the larynx may play in OSA.