<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Abstract

Identification of upper airway (UA) obstruction based on pharyngeal factors is important for obstructive sleep apnea (OSA) evaluation. This study is to assess the association between UA collapse characteristics and Friedman tongue position (FTP) in patients with OSA through drug-induced sleep endoscopy (DISE). Patients and Methods: Retrospective study in individuals with OSA who were intolerant to continuous positive airway pressure (CPAP) treatment, submitted to DISE between June 1, 2013, and July 31, 2017. All subjects were classified as having an FTP grade of I to IV, and the velum, oropharynx, tongue base, epiglottis (VOTE) classification was used to analyze the DISE findings. UA collapse characteristics by DISE and FTP grading were compared between groups. The associations between specific DISE findings and FTP were analyzed. Results: In total, 205 patients were assessed. A positive and significant correlation was identified between the presence of retropalatal complete concentric collapse (CCC) and FTP grade, according to the following distributions: I, 17.4%; II, 22.9%; III, 33.7%; and IV, 48.7% (P = 0.014). A logistic regression model revealed that CCC was associated with FTP grade IV. After adjusting for age, sex, body mass index (BMI), and tonsil size (TS), the grade IV individuals had a 4.4-fold higher risk of having CCC than grade I individuals (P = 0.026). Multiple collapse sites and palatopharyngeal or combined (palatopharyngeal and hypopharyngeal) collapse were more prevalent in grade IV individuals. Conclusion: OSA patients intolerant to CPAP have a strong positive correlation between the FTP grade and presence of retropalatal CCC. FTP grade IV is an independent risk factor for velum-CCC, controlling for sex, age, BMI, and TS grade.

Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial

“…Twenty-two patients (91.7%) had a high tongue position (FTP IV) in the current study, as well as many complete concentric collapses. A recent study identified a positive correlation between higher tongue position and complete concentric collapse, which may elucidate the findings of this study ( 33 ).…”

Barbed suture pharyngoplasty in velopharyngeal complete concentric collapse: a multicentric study

“…Given the poor prognosis that having a CCC implies, an attempt has been made to search for predictors of its presence. FTP grade IV has been highly correlated with CCC [28] with up to a 4.4-fold higher risk of having CCC than grade I individuals. A recent study by Thuler et al [29] showed a more significant presence of CCC in patients with transverse maxillary deficiency, mainly when the intermolar distance was less than 27.5 mm.…”

Impact of Upper Airway Characteristics on Disease Severity and CPAP Therapy in Chinese Patients With OSA: An Observational Retrospective Study

“…For internists, the evaluation of UA characteristics may have significance for OSA precision treatment, classification, prediction of CPAP treatment pressure, and treatment compliance (14,20).…”

“…Tonsils were classified according to their size as grades I, II, and III. Tonsil size is usually classified into grades 0-4 (19,20). In this study, for simplicity, we classified the tonsil size into the following three grades: grade 1 (defined as tonsils absent or tonsils hidden inside the pillars or tonsils extending to the pillars), grade 2 (defined as tonsils extending beyond the pillars), and grade 3 (defined as tonsils extending to the midline).…”