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Introduction Obstructive sleep apnea (OSA) is characterized by collapse of various portions of the pharynx. Epiglottic collapse can be difficult to diagnose and can affect a patient’s tolerance to continuous positive airway pressure (CPAP) or oral appliances (OA). Previous research shows a distinct nasal airflow pattern during periods of epiglottic obstruction. We sought to determine if primary epiglottic collapse noted on drug induced sleep endoscopy (DISE) would correlate with nasal airflow signals seen on home sleep studies. Methods We retrospectively analyzed the home sleep studies and DISE of 13 patients being considered for surgical therapies due to intolerance to CPAP. Characterization of nasal airflow signals as epiglottic collapse and non-epiglottic collapse was based on previously published data.[1] Airflow signals were individually scored as either epiglottic type collapse (type 1) and non-epiglottic type collapse (type 2). Total number of breaths and number of flow limited breaths were calculated by the algorithm in the home study device. Results Patients included had either complete (n=6) or no epiglottic collapse (n=7). The mean AHI 18 and 19.6, respectively. There was no difference in the fraction of type 1 breaths over total flow limited breaths between the two groups (1.1% for each group). When comparing type 1 breaths to the total number of type 1 and type 2 breaths counted, patients with complete epiglottic collapse on DISE showed a higher percentage of type 1 breaths (33%) compared to those without epiglottic collapse (23%) Conclusion Nasal airflow signal shape on home sleep studies can suggest the presence of epiglottic collapse. This type of analysis can provide a noninvasive assessment of physiology and improve treatment decisions. Support (If Any) Azarbarzin, A., et al., Predicting epiglottic collapse in patients with obstructive sleep apnoea. Eur Respir J, 2017. 50(3).

Study Design Technical Note Objective Pharyngoesophageal injury in the setting of previous anterior cervical discectomy and fusion (ACDF) is a devastating complication with no standard corrective treatment protocol. Reconstruction can thus be a complex endeavour often leading to treatment failure, recurrent pharyngoesophageal fistula and need for multiple surgical procedures. The authors present our novel approach to free tissue reconstruction of these injuries. Methods We utilized a bulk adipofascial flap to completely obliterate the retropharyngeal space and correct the pharyngoesophageal defect. Results An adipofascial flap facilitates complete separation of the injured pharyngeal/oesophageal mucosa form the cervical spine and any retained hardware. Conclusions In our hands, this technique has allowed successful repair of complex pharyngoesophageal injuries after previous ACDF procedures which includes resumption of normal oral intake.