TY - JOUR
T1 - Expiratory Velopharyngeal Obstruction
T2 - Sleep Endoscopy-Guided Treatment Strategies to Prevent Oral Breathing During Sleep
AU - Hsu, Ying Shuo
AU - Ke, Yuan Kai
AU - Kuo, Terry B.J.
AU - Chang, Yi
AU - Jacobowitz, Ofer
AU - Lin, Chia Mo
AU - Lo, Shih Chieh
AU - Yang, Cheryl C.H.
N1 - Publisher Copyright:
© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.
PY - 2024/11
Y1 - 2024/11
N2 - Objective: Obstructive sleep apnea (OSA) is a prevalent disorder, with oral breathing influencing its severity. Expiratory velopharyngeal obstruction (EVO), observed during drug-induced sleep endoscopy (DISE), may contribute to oral breathing in OSA patients. EVO results in obstruction between the pharynx and nasal cavity during expiration. This study aims to identify factors associated with positive EVO during DISE. Study Design: Case series. Setting: Tertiary Medical Center. Methods: Seventy-two OSA patients underwent clinical evaluation, polysomnography, and DISE, utilizing interventions like intraoral negative airway pressure (iNAP), mouth closure, and oral appliances (OAs) in supine positions with head rotation. The findings, classified under velopharynx, oropharynx, tongue base, epiglottis, included the presence of EVO. Results: The results demonstrated that interventions including mouth closure and iNAP were associated with increased observation of EVO (43.1% and 34.7%) compared to OA (20.1%). However, head rotation was associated with decreased presence of EVO during DISE compare to supine (26% vs 35.8%). Noticeably, per 1 year increase of age was associated with an increased odds of EVO (odds ratio: 1.03, 95% confidence interval: 1.01-1.06). However, no other baseline characteristics were significantly associated the odds of EVO. Conclusion: Our study reveals the effectiveness of head rotation and OA in reducing EVO and improving mouth breathing in OSA patients, offering valuable insights for future treatment strategies.
AB - Objective: Obstructive sleep apnea (OSA) is a prevalent disorder, with oral breathing influencing its severity. Expiratory velopharyngeal obstruction (EVO), observed during drug-induced sleep endoscopy (DISE), may contribute to oral breathing in OSA patients. EVO results in obstruction between the pharynx and nasal cavity during expiration. This study aims to identify factors associated with positive EVO during DISE. Study Design: Case series. Setting: Tertiary Medical Center. Methods: Seventy-two OSA patients underwent clinical evaluation, polysomnography, and DISE, utilizing interventions like intraoral negative airway pressure (iNAP), mouth closure, and oral appliances (OAs) in supine positions with head rotation. The findings, classified under velopharynx, oropharynx, tongue base, epiglottis, included the presence of EVO. Results: The results demonstrated that interventions including mouth closure and iNAP were associated with increased observation of EVO (43.1% and 34.7%) compared to OA (20.1%). However, head rotation was associated with decreased presence of EVO during DISE compare to supine (26% vs 35.8%). Noticeably, per 1 year increase of age was associated with an increased odds of EVO (odds ratio: 1.03, 95% confidence interval: 1.01-1.06). However, no other baseline characteristics were significantly associated the odds of EVO. Conclusion: Our study reveals the effectiveness of head rotation and OA in reducing EVO and improving mouth breathing in OSA patients, offering valuable insights for future treatment strategies.
KW - drug-induced sleep endoscopy
KW - expiratory velopharyngeal obstruction
KW - head rotation
KW - iNAP
KW - mouth closure
KW - mouth puffing
KW - obstructive sleep apnea
KW - oral appliance
KW - oral breathing
KW - target-controlled infusion
UR - http://www.scopus.com/inward/record.url?scp=85199057909&partnerID=8YFLogxK
U2 - 10.1002/ohn.902
DO - 10.1002/ohn.902
M3 - Article
C2 - 39033356
AN - SCOPUS:85199057909
SN - 0194-5998
VL - 171
SP - 1591
EP - 1600
JO - Otolaryngology - Head and Neck Surgery
JF - Otolaryngology - Head and Neck Surgery
IS - 5
ER -