Using DISE to characterize upper airway collapse and ventilatory characteristics in modeling obstructive sleep apnea.

OBJECTIVE

To evaluate potential insights gained from incorporating ventilatory measures during drug induced sleep endoscopy (DISE) as a model of obstructive sleep apnea (OSA).

STUDY

DESIGN

Cross-sectional

SETTING

Emory University Hospital Midtown

METHODS

DISE was performed on OSA patients referred for presurgical evaluation. A CPAP titration was performed under DISE to determine the critical closing pressure (Pcrit) and the pharyngeal opening pressure (Popen) of the upper airway. Airflow was captured using a calibrated pneumotachometer and allowed for calculation of the following ventilatory measures: peak airflow (Vmax), tidal volume (TV), respiratory rate (RR) and minute ventilation (MV). Comparative analysis was performed exploring differences in ventilatory measures and baseline demographics between high collapsible and low collapsible airways based on a median split of Popen.

RESULTS

Between 6/1/2022 and 6/30/2023, 36 patients were enrolled with 31 completing the study. Between the start and completion of DISE CPAP titration, there was a significant improvement in Vmax (+16 L/min, [12, 20], p<0.001), TV (+0.29 L, [0.20, 0.37], p<0.001), and MV (4.4 L/min, [3.2, 5.5], p<0.001), while RR was not significantly different (-0.31 breaths/min, [-0.96, 0.35], p=0.3). High Popen patients exhibited significantly greater Vmax (35.48 L/min (13.91) vs. 22.24 L/min (7.22), p=0.003) and were younger (55.94 yrs (10.59) vs. 68.87 yrs (8.52), p<0.001).

CONCLUSION

Incorporating quantitative ventilatory measures into DISE provides valuable insights into individualized patterns of airway collapsibility and OSA pathophysiology. This could allow for more targeted approaches to further research and eventually improve management of the disorder.