UA Collapse Patterns in Drug-Induced Sleep Endoscopy
What upper airway (UA) collapse patterns can be seen during drug-induced sleep endoscopy (DISE), and how do they compare with baseline patient characteristics?
Background: Sleep-disordered breathing (SDB) ranges from snoring to obstructive sleep apnea (OSA). The goals for UA evaluation are to improve treatment success rates by selecting the most appropriate therapeutic option for individual patients and to examine the complex pathophysiology of UA collapse in OSA. During sleep nasendoscopy or DISE, UA collapse patterns can be assessed when alternatives to continuous positive airway pressure (CPAP) treatment are being considered.
Study design: Observational study of 1,249 patients who underwent polysomnography and DISE.
Setting: Antwerp University Hospital, Antwerp, Belgium.
Synopsis: Palatal collapse was seen most frequently (81%), followed by tongue base collapse (46.6%) and hypopharyngeal collapse (38.7%). Multilevel collapse was seen in 68.2% of all patients; the most frequently observed pattern was a combination of palatal and tongue base collapse. Palatal and oropharyngeal collapse became more prevalent as body mass index (BMI) increased, but tongue base collapse rates were lower in overweight and obese patients. Hypopharyngeal collapse increased with OSA severity. After correction for age, gender, and apnea-hypopnea index (AHI) values, increasing BMI was associated with a higher probability of complete concentric palatal, partial lateral oropharyngeal, and partial lateral hypopharyngeal collapse. Anteroposterior tongue base collapse was more common with lower BMI values. Higher AHI values were associated with a higher probability of complete concentric palatal, complete concentric hypopharyngeal, and complete lateral hypopharyngeal collapse, while lower AHI values were associated with a higher probability of partial concentric palatal collapse. Limitations included subjectively assessed DISE findings, a lack of reliability testing, non-blinded assessments, and application limitations for settings with other scoring forms.
Bottom line: UA collapse patterns, as observed during DISE, can be explained in part by selected baseline characteristics, and additional evaluation remains essential for insight into the specific collapse patterns of individual patients.
Citation: Vroegop AV, Vanderveken OM, Boudewyns AN, et al. Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope. 2014;124:797-802.