Defining Epiglottic Collapses Patterns in Obstructive Sleep Apnea Patients: Francia-Lugo Classification

Area of Science:

• Sleep Medicine
• Otolaryngology
• Respiratory Medicine

Background:

• Obstructive Sleep Apnea (OSA) is a common condition characterized by repetitive upper airway collapse during sleep.
• Drug-Induced Sleep Endoscopy (DISE) is a diagnostic tool used to pinpoint the anatomical sites of airway collapse in OSA patients.
• Epiglottic collapse, a specific type of airway obstruction, is increasingly recognized as a significant factor in OSA.

Purpose of the Study:

• To review Drug-Induced Sleep Endoscopy (DISE) findings in Obstructive Sleep Apnea (OSA) patients.
• To classify distinct patterns of epiglottic collapse observed during DISE.
• To highlight the clinical significance of identifying epiglottic collapse patterns for OSA management.

Main Methods:

• Retrospective review of DISE findings in a cohort of OSA patients.
• Classification of epiglottic collapse based on observed patterns during endoscopy.
• Statistical analysis to determine the frequency and types of epiglottic collapse.

Main Results:

• Epiglottic collapse was identified in 16.4% of the studied OSA patients (12.5% primary, 3.9% secondary).
• Four main patterns of epiglottic collapse were described: Anterior-Posterior (AP) rigid 'trapdoor' (48%), AP lax 'floppy' (13.5%), Lateral-Lateral (LL) 'book' (14.5%), and secondary collapse (24%).
• The 'trapdoor' type was the most frequent pattern of primary epiglottic collapse.

Conclusions:

• Epiglottic collapse is a more frequent finding in OSA than previously thought.
• Specific patterns of epiglottic collapse can be identified and classified using DISE.
• Accurate identification of epiglottic collapse patterns is essential for guiding treatment strategies and improving outcomes in OSA patients.