Top

Published in:

01-12-2018 | ENT • Original Article

Comparison of upper airway collapse patterns and its clinical significance: drug-induced sleep endoscopy in patients without obstructive sleep apnea, positional and non-positional obstructive sleep apnea

Authors: C. Kastoer, L. B. L. Benoist, M. Dieltjens, B. Torensma, L. H. de Vries, P. E. Vonk, M. J. L. Ravesloot, N. de Vries

Published in: Sleep and Breathing | Issue 4/2018

Abstract

Purpose

To compare patient characteristics, upper airway (UA) collapse patterns and treatment outcome in obstructive sleep apnea (OSA) patients, including non-positional OSA patients (NPP) and positional OSA patients (PP), and non-OSA.

Methods

Cohort study of patients screened for OSA in 2012. Polysomnography was performed and UA was evaluated using the VOTE classification during drug-induced sleep endoscopy (DISE). Treatment outcome of MAD and UA surgery was evaluated.

Results

Eight hundred sixty patients were included. Higher BMI, larger neck circumference, and greater age were independent significant predictors for OSA. DISE was performed in 543 patients: 119 non-OSA and 424 OSA patients of whom 257 PP and 167 NPP patients. PP were younger, had smaller neck circumference, lower BMI and apnea-hypopnea index (AHI) than NPP. Collapse at velum (p < 0.001) and oropharynx (p < 0.001) significantly increased the odds for having OSA. Tongue base and epiglottis collapse were, on group level, not determinative for OSA or non-OSA. Complete concentric collapse (CCC) was observed less frequently in PP (31.5%) as compared to NPP (46.1%). After UA surgery, OSA often was cured or improved to less severe positional OSA. Lower efficacy of UA surgery was observed in PP as compared to NPP. No differences were observed in MAD treatment outcome.

Conclusions

Current study provides insight in patients screened for OSA: collapse at velum and oropharynx significantly determined presence of OSA and CCC occurred less frequently in PP compared to NPP. In addition, residual positional dependency is common after UA surgery. More trials are needed to gain insight in pathophysiology and treatment outcome.

Cartwright R, Ristanovic R, Diaz F, Caldarelli D, Alder G (1991) A comparative study of treatments for positional sleep apnea. Sleep 14(6):546–552CrossRefPubMed

Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3(4):310–318. https://doi.org/10.1016/S2213-2600(15)00043-0 CrossRefPubMedPubMedCentral

Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177(9):1006–1014. https://doi.org/10.1093/aje/kws342 CrossRefPubMedPubMedCentral

Ravesloot MJ, van Maanen JP, Dun L, de Vries N (2013) The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea-a review of the literature. Sleep Breath 17(1):39–49. https://doi.org/10.1007/s11325-012-0683-5 CrossRefPubMed

Ravesloot MJ, de Vries N (2011) One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope 121(12):2710–2716. https://doi.org/10.1002/lary.22369 CrossRefPubMed

Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep M (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619. https://doi.org/10.5664/jcsm.2172 CrossRefPubMedPubMedCentral

Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep M (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5(3):263–276PubMed

Grote L, Hedner J, Grunstein R, Kraiczi H (2000) Therapy with nCPAP: incomplete elimination of sleep related breathing disorder. Eur Respir J 16(5):921–927CrossRefPubMed

Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, Cistulli PA (2014) Oral appliance treatment for obstructive sleep apnea: an update. JClinSleep Med 10(2):215–227. https://doi.org/10.5664/jcsm.3460 CrossRef

10.

Vanderveken OM (2013) Drug-induced sleep endoscopy (DISE) for non-CPAP treatment selection in patients with sleep-disordered breathing. Sleep Breath 17(1):13–14. https://doi.org/10.1007/s11325-012-0671-9 CrossRefPubMed

11.

Vroegop AV, Vanderveken OM, Boudewyns AN, Scholman J, Saldien V, Wouters K, Braem MJ, Van de Heyning PH, Hamans E (2013) Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope 124:797–802. https://doi.org/10.1002/lary.24479 CrossRefPubMed

12.

Benoist LB, de Vries N (2015) Organization and logistics of drug-induced sleep endoscopy in a training hospital. Eur Arch Otorhinolaryngol 272(9):2557–2559. https://doi.org/10.1007/s00405-015-3665-y CrossRefPubMed

13.

Tan A, Yin JD, Tan LW, van Dam RM, Cheung YY, Lee CH (2016) Predicting obstructive sleep apnea using the STOP-Bang questionnaire in the general population. Sleep Med 27-28:66–71. https://doi.org/10.1016/j.sleep.2016.06.034 CrossRefPubMed

14.

Lan MC, Hsu YB, Lan MY, Huang YC, Kao MC, Huang TT, Chiu TJ, Yang MC (2017) The predictive value of drug-induced sleep endoscopy for CPAP titration in OSA patients. Sleep Breath. https://doi.org/10.1007/s11325-017-1600-8

15.

Oulhaj A, Al Dhaheri S, Su BB, Al-Houqani M (2017) Discriminating between positional and non-positional obstructive sleep apnea using some clinical characteristics. Sleep Breath 21(4):877–884. https://doi.org/10.1007/s11325-017-1499-0 CrossRefPubMed

16.

Oksenberg A, Gadoth N (2018) Positional patients (PP) and non positional patients (NPP) are two dominant phenotypes that should be included in the phenotypic approaches to obstructive sleep apnea. Sleep Med Rev 37:173–174. https://doi.org/10.1016/j.smrv.2017.05.004 CrossRefPubMed

17.

Richard W, Kox D, den Herder C, Laman M, van Tinteren H, de Vries N (2006) The role of sleep position in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 263(10):946–950. https://doi.org/10.1007/s00405-006-0090-2 CrossRefPubMed

18.

Ong AA, Murphey AW, Nguyen SA, Soose RJ, Woodson BT, Vanderveken OM, de Vries N, Gillespie MB (2016) Efficacy of upper airway stimulation on collapse patterns observed during drug-induced sedation endoscopy. Otolaryngol Head Neck Surg 154(5):970–977. https://doi.org/10.1177/0194599816636835 CrossRefPubMed

19.

Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A (2013) Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 188(8):996–1004. https://doi.org/10.1164/rccm.201303-0448OC CrossRefPubMedPubMedCentral

20.

Ravesloot MJL, Benoist L, van Maanen P, de Vries N (2017) Novel positional devices for the treatment of positional obstructive sleep apnea, and how this relates to sleep surgery. Adv Otorhinolaryngol 80:28–36. https://doi.org/10.1159/000470819 CrossRefPubMed

21.

Dieltjens M, Braem MJ, Van de Heyning PH, Wouters K, Vanderveken OM (2014) Prevalence and clinical significance of supine-dependent obstructive sleep apnea in patients using oral appliance therapy. J Clin Sleep Med 10(9):959–964. https://doi.org/10.5664/jcsm.4024 CrossRefPubMedPubMedCentral

22.

Lee CH, Kim SW, Han K, Shin JM, Hong SL, Lee JE, Rhee CS, Kim JW (2011) Effect of uvulopalatopharyngoplasty on positional dependency in obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 137(7):675–679. https://doi.org/10.1001/archoto.2011.99 CrossRefPubMed

23.

Lee CH, Shin HW, Han DH, Mo JH, Yoon IY, Chung S, Choi HG, Kim JW (2009) The implication of sleep position in the evaluation of surgical outcomes in obstructive sleep apnea. Otolaryngol Head Neck Surg 140(4):531–535. https://doi.org/10.1016/j.otohns.2008.12.023 CrossRefPubMed

24.

Katsantonis GP, Miyazaki S, Walsh JK (1990) Effects of uvulopalatopharyngoplasty on sleep architecture and patterns of obstructed breathing. Laryngoscope 100(10 Pt 1):1068–1072CrossRefPubMed

25.

Lee YC, Eun YG, Shin SY, Kim SW (2014) Change in position dependency in non-responders after multilevel surgery for obstructive sleep apnea: analysis of polysomnographic parameters. Eur Arch Otorhinolaryngol 271(5):1081–1085. https://doi.org/10.1007/s00405-013-2663-1 CrossRefPubMed

26.

Benoist LBL, Verhagen M, Torensma B, van Maanen JP, de Vries N (2017) Positional therapy in patients with residual positional obstructive sleep apnea after upper airway surgery. Sleep Breath 21(2):279–288. https://doi.org/10.1007/s11325-016-1397-x CrossRefPubMed

27.

van Maanen JP, Ravesloot MJ, Witte BI, Grijseels M, de Vries N (2012) Exploration of the relationship between sleep position and isolated tongue base or multilevel surgery in obstructive sleep apnea. Eur Arch Otorhinolaryngol 269(9):2129–2136. https://doi.org/10.1007/s00405-012-1995-6 CrossRefPubMedPubMedCentral

28.

Ravesloot MJL, White D, Heinzer R, Oksenberg A, Pepin JL (2017) Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med 13(6):813–824. https://doi.org/10.5664/jcsm.6622 CrossRefPubMedPubMedCentral

29.

Vonk PE, Beelen A, de Vries N (2018) Towards a prediction model for drug-induced sleep endoscopy as selection tool for oral appliance treatment and positional therapy in obstructive sleep apnea. Sleep Breath. https://doi.org/10.1007/s11325-018-1649-z

30.

Dieltjens M, Vroegop AV, Verbruggen AE, Wouters K, Willemen M, De Backer WA, Verbraecken JA, Van de Heyning PH, Braem MJ, de Vries N, Vanderveken OM (2014) A promising concept of combination therapy for positional obstructive sleep apnea. Sleep Breath 19:637–644. https://doi.org/10.1007/s11325-014-1068-8 CrossRefPubMedPubMedCentral

Title: Comparison of upper airway collapse patterns and its clinical significance: drug-induced sleep endoscopy in patients without obstructive sleep apnea, positional and non-positional obstructive sleep apnea
Authors: C. Kastoer
L. B. L. Benoist
M. Dieltjens
B. Torensma
L. H. de Vries
P. E. Vonk
M. J. L. Ravesloot
N. de Vries
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: Sleep and Breathing / Issue 4/2018
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-018-1702-y

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Comparison of upper airway collapse patterns and its clinical significance: drug-induced sleep endoscopy in patients without obstructive sleep apnea, positional and non-positional obstructive sleep apnea

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2018

Effects of 12 weeks of regular aerobic exercises on autonomic nervous system in obstructive sleep apnea syndrome patients

Detection of sleep-disordered breathing with ambulatory Holter monitoring

Quality of life in obstructive sleep apnea is related to female gender and comorbid insomnia

Association between insomnia and job stress: a meta-analysis

Assessment of oximetry-based statistical classifiers as simplified screening tools in the management of childhood obstructive sleep apnea

Can positional therapy be simple, effective and well tolerated all together? A prospective study on treatment response and compliance in positional sleep apnea with a positioning pillow

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page