Velopalatal coupling in drug-induced sleep endoscopy – a collapse pattern-based analysis

Introduction Drug-induced sleep endoscopy (DISE) is an established diagnostic procedure for the evaluation of the upper airway in obstructive sleep apnea (OSA). There, the airway opening is regularly simulated by different maneuvers. One of them is mandibular advancement by the Esmarch handle (EH). The aim of the present study was to investigate the effect of mandibular advancement on the soft palate in different collapse patterns.

Methods Retrospectively, all DISE diagnosed according to VOTE scheme in the last 15 months were included. Frequency and type of collapse at the anatomical levels, apnea-hypopnea index (AHI), body mass index (BMI), and Epworth Sleepiness Scale (ESS) were determined. The effect of EH on the anatomical levels was evaluated.

Results 61 patients could be included (f=14, m=48;54.3±12.9 y; ESS 11±5.5; AHI 30.2±19/h; BMI 29.7±4.5 kg/m2). A significant correlation was determined between AHI and BMI (p=0.02). At velum level, concentric collapse was detected in 16.4%, anterior-posterior (a.p.) collapse in 70.5%, and lateral collapse in 11.5%. Resolution of collapse was observed by EH in 71.1% of patients. However, in the presence of concentric collapse, opening was seen in only 33.3% of cases compared to 86.5% in a.p. collapse (p=0.003).

Conclusion A correlation between the success of EH on airway opening at the velum level and the pattern of palatal collapse was demonstrated. In progenitive therapy procedures but also hypoglossal stimulation, velopalatal airway opening has also relevance, so that optimization of preoperative diagnostics is of particular importance.

Conflict of Interest Der Erstautor weist auf folgenden Interessenkonflikt hin Philipp Arens and Heidi Olze received financial support from ImThera Inc. and Apnex Medical Inc. within the framework of research projects related to hypoglossal nerve stimulation therapy. In the past, Philipp Arens received a speaker’s fee for an invited talk on behalf of Inspire Medical Inc.

Publication History

Article published online:
24 May 2022