Search Results (13)

Background: Drug-induced sleep endoscopy (DISE) with a jaw-thrust maneuver is used to simulate mandibular advancement in obstructive sleep apnea (OSA), yet determinants of functional airway improvement remain incompletely defined. Objective: To identify clinical, polysomnographic, and baseline DISE anatomic factors associated with jaw-thrust responsiveness. Methods: We conducted a single-center retrospective observational study of adults with polysomnography-confirmed OSA who underwent DISE with paired baseline and jaw-thrust VOTE assessments between 1 January 2015 and 31 December 2025 (n = 355). Jaw-thrust responsiveness was defined a priori as a within-subject reduction in the number of obstructed VOTE sites (grade ≥ 1). Multivariable logistic regression was used to identify independent correlates within a prespecified explanatory modeling framework. The study was approved by the Institutional Review Board of Taipei Tzu Chi Hospital (protocol 14-IRB079), with the need for informed consent being waived. Results: Jaw thrust reduced overall obstruction burden from two (two to three) to one (one to two) sites (Wilcoxon p < 0.001). Hypopharyngeal levels demonstrated the greatest improvement, particularly at the tongue base (39.2% to 7.6%) and epiglottis (23.9% to 5.4%) (both p < 0.001). Overall, 62.8% met responder criteria and 18.9% achieved complete normalization. In multivariable analysis (n = 272), baseline tongue-base collapse (adjusted odds ratio [aOR] 2.46, 95% CI 1.20–5.04) and greater baseline multilevel obstruction burden (aOR 1.85 per SD, 95% CI 1.19–2.85) were independently associated with responsiveness, whereas conventional PSG severity metrics were not. Conclusions: In adults with OSA, jaw-thrust responsiveness during DISE is more strongly associated with baseline anatomic phenotype than with global PSG severity. Standardized DISE functional assessment may provide complementary information to support phenotype-informed selection of non-CPAP therapies, pending prospective validation. Full article

Background: The study investigates the influence of epiglottis morphology on airflow dynamics and mechanical loading using computational fluid dynamics (CFD) in patients with obstructive sleep apnea (OSA), where the epiglottis may contribute to upper airway obstructions during sleep. Methods: A two-stage analysis was conducted: first, using a simplified airway model with two distinct epiglottis shapes (flat and curved), and second, using patient-specific 3D airway geometries derived from computed tomography (CT) scans. The simplified model enabled isolated analysis of flow-related aerodynamic forces and torques acting on the epiglottis across varying flow rates and inclination angles. Results: Results showed that the flat-shaped epiglottis was subjected to higher aerodynamic loads, particularly at lower flow rates, indicating increased susceptibility to collapse. These findings were corroborated by simulations on patient-specific 3D airway models. Conclusions: The study confirms that epiglottis morphology plays a critical role in the pathogenesis of OSA and underscores the potential of CFD for personalized assessment and treatment planning. Full article

Background: Laryngomalacia is the most common cause of inspiratory stridor in infancy. While most mild cases resolve spontaneously, severe cases may require surgical intervention. We report a case of severe laryngomalacia successfully treated with correction of glosso-larynx (CGL), a surgical procedure originally developed for ankyloglossia with deviation of the epiglottis and larynx (ADEL). Methods: A 2-month-old infant with severe symptoms was evaluated using objective anatomical and functional metrics. The patient underwent CGL under local anesthesia to release restrictive tension on the hyoid-larynx complex. Results: The patient showed rapid and sustained improvement in respiratory symptoms. At the one-month follow-up, endoscopic examination confirmed functional airway expansion with limited to no morbidity. Conclusions: This case demonstrates that CGL may represent a feasible and minimally invasive therapeutic option for selected cases of severe laryngomalacia, particularly those involving complex tongue–larynx dynamics. Full article

Background: Mandibular advancement device (MAD) therapy is a non-invasive treatment for obstructive sleep apnea (OSA). Although the effect of MAD on OSA outcomes is widely known, its effect on the upper airway collapse degree remains poorly understood. This study aimed to assess the impact of MAD therapy on site-specific airway collapse degree during drug-induced sleep endoscopy (DISE). Methods: One hundred participants were recruited and underwent a baseline polysomnography. Overall, 69 participants with OSA (AHI 5–50 events/h) underwent DISE at baseline and with MAD set to 75% of maximal mandibular protrusion. Collapse degree (none, partial, complete) was evaluated at the palate, oropharynx, tongue base, hypopharynx, and epiglottis without and with MAD. Ordinal logistic regression was used to analyze changes in degree of collapse. Results: MAD therapy reduced collapse degree at the palate (OR = 5.92 [3.28; 10.66], p < 0.001), oropharynx (OR = 2.70 [1.48; 4.92], p = 0.001), tongue base (OR = 1.83 [1.32; 2.53], p < 0.001), and hypopharynx (OR = 2.90 [1.53; 5.48, p = 0.001), with no effect at the epiglottis (OR = 0.65 [0.42; 1.02], p = 0.058). Conclusions: MAD therapy reduces upper airway collapse at most anatomical levels, except at the level of the epiglottis. These findings confirm its therapeutic efficacy while underscoring the importance of identifying patients with residual or worsening collapse who may benefit from combined or alternative treatments. Full article

Drug-induced sleep endoscopy (DISE) has been progressively used to determine the individual patient responsiveness to therapy with a mandibular advancement device (MAD) for obstructive sleep apnea (OSA). This retrospective cohort study compared the general and polygraphic characteristics, as well as the sites, degrees, and patterns of upper airway collapse, in patients who responded to advancement with a titratable mandibular advancement (TMA) simulator during DISE—referred to as responders—to those in non-responders. The sample included 335 OSA patients (307 males) with a mean age of 49.98 (SD = 9.88) years, and a mean AHI of 34.14 (SD = 18.61). Once the TMA simulator customized to the patient’s dental arches was inserted and the examination was performed at 0%, 25%, 50%, and 75% of the patient’s range of antero-posterior mandibular excursion, the simulator was removed and the upper airway behavior was studied in the baseline situation. Without TMA simulator non-responders had a higher percentage of oropharyngeal complete latero-lateral and complete concentric velopharyngeal collapse. With TMA simulators, there was a significant difference between responders and non-responders in individual obstructive sites at velopharyngeal, oropharyngeal, and epiglottis levels, while at the tongue level, responders and non-responders showed the same response tendency. If confirmed in future prospective studies, these results suggest that the presence of complete latero-lateral obstruction at the oropharynx level and complete circular obstruction at the velopharynx level could be adverse phenotypes for MAD treatment outcomes in OSA patients and MAD treatment should not be considered in these patients (at least as a single therapy). Full article

The aim of this review is to investigate the state of the art among the association between Obstructive sleep apnea (OSA) and laryngomalacia, analyzing the epidemiology, the diagnostic tools, and the possible treatments available to affected patients. Laryngomalacia, characterized by the malacic consistency of the epiglottis with a tendency to collapse during inspiratory acts, producing a characteristic noise known as stridor, is a common condition in infants and particularly in those affected by prematurity, genetic diseases, craniofacial anomalies, and neurological problems. Congenital laryngomalacia, presenting with stridor within the first 15 days of life, is often self-limiting and tends to resolve by 24 months. OSA is not only a consequence of laryngomalacia but also exacerbates and perpetuates the condition. Currently, the treatments reported in the literature are based (i) on medical therapies (including watchful waiting) and (ii) on surgical treatments. Among the surgical techniques, the most described is supraglottoplasty, performed with the use of cold instruments, CO₂ LASER, transoral robotic surgery, or the microdebrider. Full article

Background: Mandibular advancement devices (MADs) are an effective treatment for patients with sleep-related breathing disorders, with variable response. Increasingly more research points to the predictive value of Drug-Induced Sleep Endoscopy (DISE) in patient selection. This study aims to analyze the changes in upper airway collapsibility using a titratable MAD simulator during DISE. Methods: This study included 104 patients with simple snoring and obstructive sleep apnea (OSA). The VOTE scale was used to assess the presence of collapses during the DISE both without and with the MAD simulator. Results: In snorers, there was a decrease in collapses at the level of the soft palate and oropharynx when the advancement was achieved. Patients with mild OSA also showed a decrease in collapses at the base of the tongue. Patients with moderate/severe OSA exhibited significant amelioration at all levels. The levels at which there were residual collapses despite the maneuver were, in order, the velopharynx, oropharynx, epiglottis, and tongue. Conclusions: The MAD simulator reduces collapsibility at all levels and in all severity groups. Residual collapses suitable for combined treatments were able to be identified. This highlights the need for individualized patient selection, as upper airway collapsibility exhibits variable improvement or worsening with the MAD simulator regardless of the severity of the condition. Full article

Obstructive Sleep Apnea (OSA) is characterized by repetitive collapse of the upper airway during sleep. Drug-Induced Sleep endoscopy (DISE) is used to identify the collapse site. Among the possible sites of collapse, the epiglottis occurs more frequently than previously described. In this study, we reviewed DISE findings and classified different epiglottic collapse patterns. We found 104 patients (16.4%) with epiglottis collapse (primary 12.5% and secondary 3.9%). We described the following patterns of epiglottis collapse: Anterior–Posterior (AP) collapse with rigid component “trapdoor type” (48%); AP collapse with lax component “floppy type” (13.5%); Lateral– Lateral (LL) collapse with omega shape component “book type” (14.5%); and secondary due to lateral pharyngeal wall or tongue base collapse (24%). The identification of the epiglottic collapse pattern is crucial in decision-making when attempting to ameliorate OSA. These findings in OSA phenotyping could influence the type of treatment chosen. Full article

The critical role of epiglottis in airway narrowing contributing to obstructive sleep apnoea (OSA) and continuous positive airway pressure (CPAP) intolerance has recently been revealed. This systematic review was conducted to evaluate available surgical treatment options for epiglottic collapse in adult patients with OSA. The Pubmed and Scopus databases were searched for relevant articles up to and including March 2022 and sixteen studies were selected. Overall, six different surgical techniques were described, including partial epiglottectomy, epiglottis stiffening operation, glossoepiglottopexy, supraglottoplasty, transoral robotic surgery, maxillomandibular advancement and hypoglossal nerve stimulation. All surgical methods were reported to be safe and effective in managing selected OSA patients with airway narrowing at the level of epiglottis. The surgical management of epiglottic collapse can improve OSA severity or even cure OSA, but can also improve CPAP compliance. The selection of the appropriate surgical technique should be part of an individualised, patient-specific therapeutic approach. However, there are not enough data to make definitive conclusions and additional high-quality studies are required. Full article

Purpose: Evaluate the effectiveness of the head-of-bed elevation position (HOBE) with a 30° elevation of the head and trunk, in improving obstruction of the upper airways in obstructive sleep apnea (OSA) patients. A prospective trial simultaneously performing drug-induced sleep endoscopy (DISE) and polysomnography (PSG) tests was performed. Methods: Forty-five patients were included in the prospective study protocol. All patients enrolled in the study and underwent the following evaluations: (1) a drug-induced sleep endoscopy, with an evaluation of obstructions and collapse of the upper airways at 0° and in a HOBE position, with head and trunk elevation of 30°; (2) an overnight PSG assessment in the hospital with head and trunk elevation from 0° to 30° during the night; (3) a questionnaire to evaluate the feedback of patients to sleeping with head-of-bed elevation. Results: Velum (V) and oropharynx lateral wall (O) collapses were reduced in the 30° up position. There were no statistical differences that emerged in the obstruction of the tongue base and epiglottis between the 0° position and the 30° up position (p > 0.05). The average AHI score changed from 23.8 ± 13.3 (0° supine position) to 17.7 ± 12.4 (HOBE position), with a statistical difference (p = 0.03); the same statistical difference emerged in the percentage of apneas that decreased from 55 ± 28.1 to 44 ± 25.8 (p = 0.05). Conclusions: By adopting the HOBE position with 30° elevation of the head and trunk, it is possible to obtain a reduction of upper airways collapses and an improvement of apnea/hypopnea events and nightly respiratory outcomes. Full article

Drug-induced sleep endoscopy (DISE) reveals epiglottic collapse to be a frequent cause of obstructive sleep apnea (OSA) and intolerance of positive airway pressure (PAP). These patients require different management. This prospective study aimed to compare transoral laser epiglottopexy outcomes in patients with OSA caused by epiglottic collapse with the patients’ previous PAP outcomes. Fifteen consecutive adult patients with OSA and epiglottic collapse during DISE were included; ten were analyzed. Before inclusion, PAP was indicated and ineffective in six patients, one of whom underwent unsuccessful uvulopalatopharyngoplasty. PAP was performed during DISE in all patients before epiglottopexy and was uniformly ineffective. ENT control was performed at 1 week and 1 month, and control limited polygraphy to 6 months after surgery. The apnea–hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) were significantly improved (p < 0.001 and p = 0.003, respectively) in all patients after epiglottopexy. Surgery was successful in 9/10 patients; the remaining patient had a significantly decreased AHI and could finally tolerate PAP. Transoral laser epiglottopexy is used to treat OSA in patients with epiglottic collapse. Unlike other methods, it significantly reduces both AHI and ESS and should be considered for these patients. An active search for OSA patients with epiglottic collapse is recommended to prevent treatment failure. Full article

The Velum, Oropharynx, Tongue base and Epiglottis (VOTE) classification on drug-induced sleep endoscopy (DISE) is used widely for obstructive sleep apnea (OSA) syndrome, though research into comparative physical examinations with VOTE on DISE is still limited. The aim of this study was to evaluate the relationship between the findings of physical examinations and DISE in patients with OSA. Fifty-five patients with OSA were enrolled in this retrospective study. All of the patients received clinical explorations including a Brodsky classification, a modified Mallampati score (MMS), a modified Friedman’s staging system, and a Muller’s test. Drug-induced sleep endoscopy was further evaluated in the operating room. There were significant relationships between Brodsky classification, modified Friedman’s staging system, Muller’s test and oropharynx collapse during DISE (p < 0.05). Brodsky classification, MMS, modified Friedman’s staging system and retropalatal lateral-to-lateral (L–L) collapse of Muller’s test were significantly correlated with VOTE count (p < 0.05). The concordance between VOTE under DISE and Brodsky classification or modified Friedman’s staging system was moderate. In contrast, the concordance between VOTE under DISE and MMS or Muller’s test was slight. The study revealed that Brodsky classification and Friedman staging had a significant relationship with DISE on the velum and oropharynx, but the level of tongue base is uncertain between DISE and MMS. Correlation of awake evaluation of tongue base is still not correlated to the DISE findings. Pre-treatment evaluation of DISE is still warranted. Full article