Epiglottic Collapse in Obstructive Sleep Apnea

Bae, Mi Rye; Chung, Yoo‐Sam

doi:10.17241/smr.2021.00948

Cited by 9 publications

(8 citation statements)

References 35 publications

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“…Kim et al confirmed this assertion by publishing an article with an OSA patient with worsening epiglottic collapse during CPAP application in a video presentation [45]. In case of residual obstruction after CPAP, an upper airway reassessment should be performed to determine the presence and type of epiglottic collapse [46], as these patients require different management.…”

Section: Discussionmentioning

confidence: 95%

Surgical Treatment Options for Epiglottic Collapse in Adult Obstructive Sleep Apnoea: A Systematic Review

Kyriaki

Chaidas

2022

Life

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The critical role of epiglottis in airway narrowing contributing to obstructive sleep apnoea (OSA) and continuous positive airway pressure (CPAP) intolerance has recently been revealed. This systematic review was conducted to evaluate available surgical treatment options for epiglottic collapse in adult patients with OSA. The Pubmed and Scopus databases were searched for relevant articles up to and including March 2022 and sixteen studies were selected. Overall, six different surgical techniques were described, including partial epiglottectomy, epiglottis stiffening operation, glossoepiglottopexy, supraglottoplasty, transoral robotic surgery, maxillomandibular advancement and hypoglossal nerve stimulation. All surgical methods were reported to be safe and effective in managing selected OSA patients with airway narrowing at the level of epiglottis. The surgical management of epiglottic collapse can improve OSA severity or even cure OSA, but can also improve CPAP compliance. The selection of the appropriate surgical technique should be part of an individualised, patient-specific therapeutic approach. However, there are not enough data to make definitive conclusions and additional high-quality studies are required.

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Section: Discussionmentioning

confidence: 95%

Surgical Treatment Options for Epiglottic Collapse in Adult Obstructive Sleep Apnoea: A Systematic Review

Kyriaki

Chaidas

2022

Life

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“…If there is a long glosso-epiglottic fold and therefore a lot more space between the base of the tongue and the epiglottis, then one would more likely encounter the trap-door phenomenon. Conversely, if the valecullae are extremely narrow with a short gloss-epiglottic fold and a shorter but tighter glosso-epiglottic fold, then the pattern of collapse would be different [ 28 ]. Additionally, an ary-epiglottis fold pattern of collapse may also be observed, which is similar to laryngomalacia in pediatric populations.…”

Section: Discussionmentioning

confidence: 99%

A Critical Analysis of Pharyngeal Patterns of Collapse in Obstructive Sleep Apnea: Beyond the Endoscopic Classification Systems

De Vito,

Olszewska,

Kotecha

et al. 2023

JCM

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(1) Background: Drug-Induced Sleep Endoscopy (DISE) enables the three-dimensional and dynamic visualization of the upper airway (UA) during sleep, which is useful in selecting the best treatment option for obstructive sleep apnea (OSA) patients, particularly for surgical procedures. Despite international consensus statements or position papers, a universally accepted DISE methodology and classification system remain a controversial open question. (2) Methods: A review of the English scientific literature on DISE related to endoscopic classification systems and surgical outcome predictors (3) Results: Of the 105 articles, 47 were included in the analysis based on their content’s relevance to the searched keywords. (4) Conclusions: A final report and scoring classification system is not universally accepted; the most internationally applied endoscopic classification system during DISE does not cover all patterns of events that occur simultaneously during the endoscopic examination, highlighting that several configurations of collapse and obstruction at different UA levels could be observed during DISE, which should be described in detail if DISE has to be considered in the decision-making process for the UA surgical treatment in OSA patients and if DISE has to have a role as a predictive factor for surgical outcomes analysis.

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“…Studies have classified EC as apEC and latEC with partial or complete types. The most common type, complete apEC, has an incidence rate of 16.8% to 65.4%; latEC is the least common type 17 . We screened 352 OSA patients, and the final analysis included 40 patients with apEC (35 complete and 5 partial types) and 14 patients with latEC (11 complete and 3 partial types).…”

Section: Discussionmentioning

confidence: 99%

Potential Treatments for Epiglottic Collapse in Obstructive Sleep Apnea: How Modified Drug‐Induced Sleep Endoscopy Help?

Shih,

Chen,

Lin

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveIn patients with obstructive sleep apnea (OSA), epiglottic collapse (EC) constitutes a major factor in the failure of continuous positive airway pressure therapy and uvulopalatopharyngoplasty. This study explored treatments that can improve EC in patients with OSA through drug‐induced sleep endoscopy with target‐controlled infusion (TCI‐DISE).Study DesignRetrospective cohort study.SettingTertiary center.MethodsThis study screened 352 OSA patients who underwent TCI‐DISE between 2016 and 2022. Fifty‐four patients with EC were included in the final analysis. EC severity was assessed multiple times through TCI‐DISE with different interventions.ResultsThe application of these interventions in patients with anteroposterior epiglottic collapse (apEC) led to a significant decrease in apEC severity from total to partial or no obstruction in 60.0% of patients by head rotation, in 53.6% by mouth closure, in 47.4% who received oral appliances (OA), and in 28.0% who received intermittent negative airway pressure (iNAP). With simultaneous head rotation, apEC severity decreased more significantly from total to partial or no obstruction in 77.8% of patients by mouth closure, in 70.3% who received OA, and in 68.0% who received iNAP. Lateral epiglottic collapse (latEC) severity decreased in 53.8% of patients after OA use and in 61.5% of patients with OA use and head rotation.ConclusionThis study identified head rotation with mouth closure as the most effective treatment for apEC through TCI‐DISE. Patients with latEC had higher weight, apnea‐hypopnea index, and body mass index compared with patients with apEC. OA use with head rotation appeared more effective in latEC through TCI‐DISE.

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Epiglottic Collapse in Obstructive Sleep Apnea

Cited by 9 publications

References 35 publications

Surgical Treatment Options for Epiglottic Collapse in Adult Obstructive Sleep Apnoea: A Systematic Review

Surgical Treatment Options for Epiglottic Collapse in Adult Obstructive Sleep Apnoea: A Systematic Review

A Critical Analysis of Pharyngeal Patterns of Collapse in Obstructive Sleep Apnea: Beyond the Endoscopic Classification Systems

Potential Treatments for Epiglottic Collapse in Obstructive Sleep Apnea: How Modified Drug‐Induced Sleep Endoscopy Help?

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