Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse

Tan, Shi Nee; Kim, Jong Min; Kim, Jisun; Sung, Chung Ki; Kim, Hong Chan; Lee, Jong-Ho; Lim, Sang Chul; White, David P.; Yang, Hyung Chae; Wellman, D.A.

doi:10.1371/journal.pone.0268455

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…8 Tan et al reported that EC improved even with a small degree of head rotation, and a greater degree of rotation yielded additional responders. 18 In our study, 28 out of 39 patients with apEC (71.8%) experienced decreased EC severity after head rotation in the supine position.…”

Section: Discussionmentioning

confidence: 46%

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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Section: Discussionmentioning

confidence: 46%

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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“…En un estudio reciente, Tan et al evidencian que la rotación de la cabeza, aunque sea mínima, mejora la obstrucción de la vía aérea en pacientes con AOS, especialmente en el grupo de pacientes con una AOS leve y que no presentan colapso lateral orofaríngeo [217].…”

Section: Diagnóstico De Apnea Obstructiva Del Sueño Posicionalunclassified

Apnea obstructiva del sueño posicional. Implicaciones clínicas.

Arroyo Domingo

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Background. Obstructive sleep apnea (OSA) is a highly prevalent disease with major negative implications both for the patient and the health system. Patients showing a higher rate of respiratory events while sleeping in the supine position suffers from the so called positional obstructive sleep apnea (POSA), which is one of the most frequent OSA phenotypes (56%-75%).There is not a consensus within the medical community concerning POSA diagnosis. Since the first definition of positional patients by Cartwright as those showing an apnea-hypopnea index (AHI) in the supine position at least twice the AHI in the non-supine position, numerous amendments have been performed.Recently, the Amsterdam Positional OSA Classification (APOC) criterion has been proposed, which attempts to identify those patients who could benefit the most from a positional therapy due to the removal of positional-related apneas leads to a nonpathologic condition despite residual events or, alternatively, because the absence of positional apneas leads to a significant reduction of the severity of the disease. Are there differences in the severity degree of POSA and Non-POSA patients? Published works are contradictory. Some researchers consider POSA as a milder phenotype of the disease. On the contrary, other authors link supinedependent apneas to more frequent, longer, and severe events, with deeper desaturations, and with a more severe bradycardia-tachycardia pattern. Thus, further research is needed to gain insight into the actual effects of positional apneas. Hypotheses and objectives.The main hypothesis in the present PhD Thesis is that the variability linked to the different existing POSA definitions could affect the viii prevalence, clinical characteristics, and management of patients, and thus, to their health and quality of life. Particularly, as a secondary question, it is hypothesized that positional patients could have higher cardiac autonomic disbalance than nonpositional subjects. Accordingly, the main aim of the PhD Thesis is to characterize patients diagnosed as POSA according to the new APOC criteria and thoroughly analyze their differences compared to a group of non-positional subjects. The following secondary objectives are also stated: to estimate the POSA prevalence according to the existing positional criteria; to analyze the differences among the POSA categories defined by the APOC criterion; to analyze the polysomnographic and pulseoximetric indexes of POSA and Non-POSA patients; to study the influence of POSA in sleep quality, quality of life, and CPAP treatment adherence; to analyze its effect on cardiac autonomic modulation. Materials and methods. A total of 409 patients consecutively referred to the sleep unit of the Pneumology Service of the Río Hortega University Hospital of Valladolid between July 2016 and April 2018 were included in the research. All patients underwent unsupervised nocturnal polysomnography (PSG) at home and simultaneous nocturnal pulse oximetry recording by means of a portable pulseoximeter. A triax...

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Expiratory Velopharyngeal Obstruction: Sleep Endoscopy‐Guided Treatment Strategies to Prevent Oral Breathing During Sleep

Hsu,

Ke,

Kuo

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveObstructive sleep apnea (OSA) is a prevalent disorder, with oral breathing influencing its severity. Expiratory velopharyngeal obstruction (EVO), observed during drug‐induced sleep endoscopy (DISE), may contribute to oral breathing in OSA patients. EVO results in obstruction between the pharynx and nasal cavity during expiration. This study aims to identify factors associated with positive EVO during DISE.Study DesignCase series.SettingTertiary Medical Center.MethodsSeventy‐two OSA patients underwent clinical evaluation, polysomnography, and DISE, utilizing interventions like intraoral negative airway pressure (iNAP), mouth closure, and oral appliances (OAs) in supine positions with head rotation. The findings, classified under velopharynx, oropharynx, tongue base, epiglottis, included the presence of EVO.ResultsThe results demonstrated that interventions including mouth closure and iNAP were associated with increased observation of EVO (43.1% and 34.7%) compared to OA (20.1%). However, head rotation was associated with decreased presence of EVO during DISE compare to supine (26% vs 35.8%). Noticeably, per 1 year increase of age was associated with an increased odds of EVO (odds ratio: 1.03, 95% confidence interval: 1.01‐1.06). However, no other baseline characteristics were significantly associated the odds of EVO.ConclusionOur study reveals the effectiveness of head rotation and OA in reducing EVO and improving mouth breathing in OSA patients, offering valuable insights for future treatment strategies.

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Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse

Cited by 5 publications

References 29 publications

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

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

Apnea obstructiva del sueño posicional. Implicaciones clínicas.

Expiratory Velopharyngeal Obstruction: Sleep Endoscopy‐Guided Treatment Strategies to Prevent Oral Breathing During Sleep

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