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

Abstract

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.