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Updated: Jun 28, 2025
07:54
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
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Association Between Soft Tissue Measures From Computed Tomography and Upper Airway Collapsibility on Drug-Induced
Eric R Thuler1, Manan H Parekh1, Jules G Rodin1
1Department of Otorhinolaryngology, Division of Sleep Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Summary
Greater tongue volume is linked to increased airway collapsibility in obstructive sleep apnea (OSA) patients. This finding, from drug-induced sleep endoscopy (DISE) and CT scans, highlights soft tissue
Area of Science:
- Sleep Medicine
- Otolaryngology
- Radiology
Background:
- Positive airway pressure (PAP) titration during drug-induced sleep endoscopy (DISE) offers objective upper airway collapsibility measures.
- Previous studies linked skeletal measurements to collapsibility, but the impact of soft tissue dimensions remained unclear.
Purpose of the Study:
- To investigate the relationship between upper airway soft tissue volumes (soft palate, pharyngeal lateral walls, tongue) and collapsibility metrics.
- To determine if soft tissue dimensions influence airway collapsibility during PAP titration in obstructive sleep apnea (OSA) patients.
Main Methods:
- Cross-sectional analysis of a prospective cohort from an academic medical center.
- Patients undergoing PAP alternative therapy for OSA had computed tomography (CT) scans and DISE.
- CT focused on soft tissue volumes; DISE with PAP (DISE-PAP) determined pharyngeal critical pressure (PcritA) and pharyngeal opening pressure (PhOP).
Main Results:
- 139 subjects completed CT and DISE-PAP.
- Adjusted for clinical factors and skeletal volumes, larger tongue volume correlated with more positive PhOP (ρ=0.20, P=0.02) and PcritA (ρ=0.16, P=0.07).
- Soft palate and lateral pharyngeal wall volumes showed no association with collapsibility measures; smaller retropalatal area and intramandibular volume were linked to increased collapsibility.
Conclusions:
- Increased tongue volume is associated with greater airway collapsibility in OSA patients, even after controlling for clinical and skeletal factors.
- These findings suggest that tongue volume, potentially in conjunction with smaller skeletal dimensions, contributes significantly to OSA severity.
- Understanding soft tissue contributions to airway collapsibility can refine OSA treatment strategies.
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