Patients with epiglottic collapse showed less severe obstructive sleep apnea and good response to treatment other than continuous positive airway pressure: a case-control study of 224 patients

Abstract

The purpose of this study was to analyze patients with epiglottic collapse, especially their clinical characteristics related to obstructive sleep apnea and phenotype labeling using drug-induced sleep endoscopy. Methods: An age-sex matched case-control study was conducted to compare the clinical characteristics of patients with epiglottic collapse (Epi group) and patients without epiglottic collapse (non-Epi group). All patients underwent drug-induced sleep endoscopy January, 2015, to March, 2019, in a tertiary hospital for suspected sleep apnea symptoms. Demographic factors, underlying disease, overnight polysomnography, and their phenotype labeling using drug-induced sleep endoscopy were analyzed. Results: There was no difference in age, sex, the prevalence of hypertension, diabetes, cerebrovascular disease, and coronary artery disease. However, the body mass index was significantly lower in patients in the Epi group (P <.001). Additionally, the apnea-hypopnea index was lower (P =.001), and the lowest oxygen saturation was significantly higher in the Epi group (P = .042). The phenotype labeling on drug-induced sleep endoscopy showed that the prevalence of velum concentric collapse and oropharyngeal lateral wall collapse was lower, and that of tongue-base collapse was higher in the Epi group. Multilevel obstructions were more common in the Epi group. However, the Epi group showed a good response to mandibular advancement or positional therapy. Conclusions: Although there was no difference in the underlying characteristics and self-reported symptom scores between the groups, the patients with epiglottic collapse showed significantly lower body mass index and obstructive sleep apnea severity. Additionally, patients with epiglottic collapse were expected to respond well to oral devices or positional therapy.

Anatomy and Pathophysiology of Upper Airway Obstructive Sleep Apnoea: Review of the Current Literature

“…This study highlighted an important clinical characteristic of OSA patients with a low BMI. In addition, these patients exhibited unfavourable characteristics for CPAP use [80] but demonstrated a good response to head rotation or MAD therapy [15,78].…”

“…The site of obstruction can be identified using DISE, and each obstruction site may be correlated with an increase in OSA severity. However, some recent studies have reported a negative cor- relation between a specific type of anatomical obstruction and OSA severity [15,73,74]. This leads to the question of whether the collapse site identified using DISE can be regarded as a phenotype predicting overall disease severity.…”

“…In such a situation, partial epiglottectomy has been shown to improve residual AHI [74]. In addition, patients with epiglottic collapse exhibited less severe OSA and lower BMI [15,88]. Thus, they demonstrated a good response to non-CPAP treatments such as positional therapy or MAD [14,15,88].…”

“…In addition, patients with epiglottic collapse exhibited less severe OSA and lower BMI [15,88]. Thus, they demonstrated a good response to non-CPAP treatments such as positional therapy or MAD [14,15,88]. However, the pathophysiology regarding how and why it occurs remains controversial.…”

Non-acid reflux and sleep apnea: The importance of drug induced sleep endoscopy

“…Treatment with CPAP devices may aggravate airway obstruction in patients with a collapsed epiglottis [ 4 ]. Surgery in these cases could be an option [ 5 ], but it is always essential to evaluate the reason for collapse.…”