Drug-induced sleep endoscopy: the effect of different passive maneuvers on the distribution of collapse patterns of the upper airway in obstructive sleep apnea patients.

Abstract

To evaluate the effect of different passive maneuvers (lateral head rotation and jaw thrust) during drug-induced sleep endoscopy (DISE) on distribution of collapse patterns at the level of velum, oropharynx, tongue base, and epiglottis (VOTE). Retrospective, single-center cohort study. Patients diagnosed with OSA who underwent DISE between August 2016 and February 2017 were included. During DISE procedure lateral head rotation, jaw thrust and a combination of both were applied and scored by VOTE obstruction level. Also, the effect of these maneuvers was analyzed for complete concentric collapse (CCC) versus complete non-concentric collapse (CNCC) subgroups. Two hundred patients were included (161 male (80.5%), mean age 50.1 ± 11.7years, median AHI 19.2 (11.7, 31.0) events/h). For lateral head rotation, significant improvement in upper airway collapse at all levels was observed, with exception of the level of the oropharynx, where an increase in obstruction was seen. Jaw thrust resulted in a significant decrease of collapse on all four VOTE levels. The CCC group responded similarly to the CNCC group when only one maneuver was applied, but the CCC group showed less improvement when both maneuvers were combined. This study gives new insights into the changes in distribution of collapse patterns when passive maneuvers are applied during DISE. Jaw thrust and lateral head rotation gave improvement of obstruction mostly in line with previous research. The CNCC and CCC groups responded similarly to application of a single maneuver, but there was a significant difference found when both maneuvers were combined.