Usefulness of Sleep Endoscopy in Predicting Positional Obstructive Sleep Apnea

Abstract

Objectives: 1) Evaluate the ability of drug-induced sleep endoscopy (DISE) to identify patients with positional obstructive sleep apnea (OSA) and 2) assess the effects of body position on the upper airway during sleep. Study Design. Prospective, controlled study. Setting. Academic tertiary care center. Methods: Twenty patients with OSA were enrolled. They were equally divided into two groups depending on presence of positional OSA on polysomnogram. Positional OSA was defined by non-supine 50% reduction in apnea-hypopnea index. Patients were placed in both lateral and supine sleep positions and DISE performed. Upper airway collapse was compared between the sleep positions and between the two groups. Results: Most patients (80%) demonstrated multilevel obstruction on DISE. All positional OSA patients demonstrated at least a partial improvement in collapse while in the lateral sleep position. Most of the reduction in collapse involved the tongue base and epiglottis (P < .05). Sleep position did not alter the upper airway morphology of patients without positional OSA. Tongue base and epiglottic obstruction while supine was significantly greater in positional as compared to non-positional OSA patients (P < .05). Apnea-hypopnea index and body mass index were not significantly different between the two groups. Conclusions: Sleep position changes the upper airway morphology of positional OSA patients on DISE. Hypopharyngeal collapse was the primary site that improved with change in position. DISE in multiple sleep positions should be considered as part of a minimally invasive approach to surgical therapy of OSA.