Role of drug-induced sleep endoscopy in evaluation of positional vs non-positional OSA
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(2020) 49:83
ORIGINAL RESEARCH ARTICLE
Open Access
Role of drug-induced sleep endoscopy in evaluation of positional vs non-positional OSA Ming-Chin Lan1,2, Stanley Yung-Chuan Liu3, Ming-Ying Lan4,5, Yun-Chen Huang1,2, Tung-Tsun Huang1,2 and Yen-Bin Hsu4,5*
Abstract Background: The study aimed to evaluate the anatomical differences between positional and non-positional OSA, and to identify the potential predictors for distinguishing between these two types of OSA. Methods: A cross-sectional study of 230 consecutive patients with OSA undergoing DISE (Drug-induced Sleep Endoscopy) was carried out at a tertiary academic medical center. The factors correlating with positional and nonpositional OSA were analyzed, including clinical characteristics, polysomnography data, and DISE findings. Results: Univariate analysis revealed that non-positional dependency was correlated with a higher BMI (p < 0.001), neck circumference (p < 0.001), modified Mallampati score (p = 0.003), AHI (p < 0.001), degree of velum concentric collapse (p = 0.004), degree of oropharyngeal lateral wall collapse (p < 0.001), and degree of tongue base anteroposterior collapse (p = 0.004). Multivariate analysis revealed that oropharyngeal lateral wall collapse (OR = 1.90, p = 0.027) was the only anatomical factor significantly predicted non-positional dependency in OSA patients. AHI (OR = 1.04, p < 0.001), although significant, made only a marginal contribution to the prediction of non-positional dependency. Conclusions: Oropharyngeal lateral wall collapse was identified as the only anatomical predictor for non-positional dependency in OSA patients. Therefore, further treatment modalities should address the distinct anatomical trait between positional and non-positional OSA. Keywords: Obstructive sleep apnea, Positional OSA, Non-positional OSA, Sleep position, Positional dependency, Nonpositional dependency, Drug-induced sleep endoscopy
Introduction Obstructive sleep apnea (OSA) is a complex disorder with repeated upper airway obstruction during sleep, which results from an interaction between structurally vulnerable anatomy, compromised muscle responsiveness, low respiratory arousal threshold, and unstable ventilatory control [1]. * Correspondence: [email protected] 4 Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan, R.O.C. 5 School of Medicine, National Yang-Ming University, Taipei, Taiwan Full list of author information is available at the end of the article
The influence of sleep position on the severity of OSA is possibly related to the effect of gravity. The gravitational effect on the unstable upper airway exacerbates in the supine position, while the detrimental effect of gravity on the upper airway reduces in the lateral decubitus position. Positional OSA, first describe by Cartwright et al., was defined as a supine apnea-hypopnea index (AHI) at least two times greater than a non-supine AHI [2]. A majority of OSA population consists
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