Epiglottis collapse in adult obstructive sleep apnea: A systematic review

Torre, C. de la; Camacho, Macario; Liu, Stanley Yung‐Chuan; Huon, Leh-Kiong; Capasso, Robson

doi:10.1002/lary.25589

Cited by 121 publications

(113 citation statements)

References 46 publications

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“…Indeed, available evidence indicates that identifying the epiglottic collapse has important implications for OSA management[9, 32]. The method developed in this study can be used to test whether epiglottic collapse, assessed using this approach, predicts responses to therapy, including failure of oral appliances[9], surgery[33], increased occurrence of collapse on CPAP[10, 11, 32], and effectiveness of positional therapy[17, 32].…”

Section: Discussionmentioning

confidence: 99%

“…The method developed in this study can be used to test whether epiglottic collapse, assessed using this approach, predicts responses to therapy, including failure of oral appliances[9], surgery[33], increased occurrence of collapse on CPAP[10, 11, 32], and effectiveness of positional therapy[17, 32]. In addition, its utility as a screening tool for epiglottis-related surgery can be tested.…”

Section: Discussionmentioning

confidence: 99%

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Predicting epiglottic collapse in patients with obstructive sleep apnoea

et al. 2017

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Objectives Obstructive sleep apnea (OSA) is characterized by pharyngeal obstruction occurring at different sites. Endoscopic studies reveal that epiglottic collapse renders patients at higher risk of failed oral appliance therapy or accentuated collapse on CPAP. Diagnosing epiglottic collapse currently requires invasive studies (imaging, endoscopy). Alternatively, we propose that epiglottic collapse can be detected from distinct airflow patterns it produces during sleep. Methods Twenty-three OSA patients underwent natural sleep endoscopy. A total of 1232 breaths were scored as epiglottic/non-epiglottic collapse. Several flow characteristics were determined from the flow signal (recorded simultaneously with endoscopy) and used to build a predictive model to distinguish epiglottic from non-epiglottic collapse. Additionally, ten OSA patients were studied to validate the pneumotachograph flow features using nasal pressure signals. Results Epiglottic collapse was characterized by a rapid fall(s) in the inspiratory flow, more variable inspiratory and expiratory flow, and reduced tidal volume. The cross-validated accuracy was 84%. Predictive features obtained from pneumotachograph flow and nasal pressure were strongly correlated. Conclusions This study demonstrates that epiglottic collapse can be identified from the airflow signal measured during a sleep study. This method may enable clinicians to use clinically-collected data to characterize underlying physiology and improve treatment decisions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predicting epiglottic collapse in patients with obstructive sleep apnoea

et al. 2017

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“…19 Before the use of DISE to evaluate upper airway obstruction, the prevalence of epiglottic collapse was estimated to be 12% of OSA patients. However, studies performed during (drug-induced) sleep have demonstrated a much higher prevalence.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse

Marques

Genta

Sands

et al. 2017

Sleep

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Objectives:In some patients, obstructive sleep apnea (OSA) can be resolved with improvement in pharyngeal patency by sleeping lateral rather than supine, possibly as gravitational effects on the tongue are relieved. Here we tested the hypothesis that the improvement in pharyngeal patency depends on the anatomical structure causing collapse, with patients with tongue-related obstruction and epiglottic collapse exhibiting preferential improvements. Methods: Twenty-four OSA patients underwent upper airway endoscopy during natural sleep to determine the pharyngeal structure associated with obstruction, with simultaneous recordings of airflow and pharyngeal pressure. Patients were grouped into three categories based on supine endoscopy: Tongue-related obstruction (posteriorly located tongue, N = 10), non-tongue related obstruction (collapse due to the palate or lateral walls, N = 8), and epiglottic collapse (N = 6). Improvement in pharyngeal obstruction was quantified using the change in peak inspiratory airflow and minute ventilation lateral versus supine. Results: Contrary to our hypothesis, patients with tongue-related obstruction showed no improvement in airflow, and the tongue remained posteriorly located while lateral. Patients without tongue involvement showed modest improvement in airflow (peak flow increased 0.07 L/s and ventilation increased 1.5 L/min). Epiglottic collapse was virtually abolished with lateral positioning and ventilation increased by 45% compared to supine position. Conclusions: Improvement in pharyngeal patency with sleeping position is structure specific, with profound improvements seen in patients with epiglottic collapse, modest effects in those without tongue involvement and-unexpectedly-no effect in those with tongue-related obstruction. Our data refute the notion that the tongue falls back into the airway during sleep via gravitational influences.

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“…These findings are consistent with the understanding that the nose generally is not considered a site of obstruction during apneic events, since the nose does not move dynamically. The more susceptible areas of collapse include the oropharynx, hypopharynx, soft palate, and epiglottis in OSA patients [21, 33]. …”

Section: Discussionmentioning

confidence: 99%

Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

et al. 2016

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Objective. To systematically review the international literature for studies evaluating internal (NoZovent) and external (Breathe Right Strips) nasal dilators as treatment for obstructive sleep apnea (OSA). Study Design. Systematic review with meta-analysis. Methods. Four databases, including PubMed/MEDLINE, were searched through September 29, 2016. Results. One-hundred twelve studies were screened, fifty-eight studies were reviewed, and fourteen studies met criteria. In 147 patients, the apnea-hypopnea index (AHI) was reported, and there was an improvement from a mean ± standard deviation (M ± SD) of 28.7 ± 24.0 to 27.4 ± 23.3 events/hr, p value 0.64. There was no significant change in AHI, lowest oxygen saturation, or snoring index in OSA patients when using nasal dilators. However, a subanalysis demonstrated a slight reduction in apnea index (AI) with internal nasal dilators (decrease by 4.87 events/hr) versus minimal change for external nasal dilators (increase by 0.64 events/hr). Conclusion. Although nasal dilators have demonstrated improved nasal breathing, they have not shown improvement in obstructive sleep apnea outcomes, with the exception of mild improvement in apnea index when internal nasal dilators were used.

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Epiglottis collapse in adult obstructive sleep apnea: A systematic review

Abstract: NA.

Cited by 121 publications

References 46 publications

Predicting epiglottic collapse in patients with obstructive sleep apnoea

Predicting epiglottic collapse in patients with obstructive sleep apnoea

Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse

Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

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