Treatment Patterns in Obstructive Sleep Apnea With Complete Concentric Collapse on Sleep Endoscopy

Area of Science:

• Sleep Medicine
• Otolaryngology
• Respiratory Medicine

Background:

• Obstructive sleep apnea (OSA) significantly impacts patient health and quality of life.
• Positive airway pressure (PAP) therapy is a common treatment, but adherence can be challenging.
• Drug-induced sleep endoscopy (DISE) helps identify airway collapse patterns, such as complete concentric collapse (CCC) at the velum.

Purpose of the Study:

• To evaluate treatment outcomes in patients with OSA and velum CCC who are intolerant to PAP therapy.
• To compare treatment success rates between patients with and without velum CCC.
• To assess the efficacy of surgical interventions in this specific patient group.

Main Methods:

• Retrospective review of patients undergoing DISE between January 2013 and March 2023.
• Inclusion criteria: moderate-to-severe OSA, PAP intolerance/failure, and available treatment status records.
• Analysis of treatment outcomes based on the presence of velum CCC and subsequent interventions.

Main Results:

• 17% of patients undergoing DISE had velum CCC (118/689).
• Only 22% of patients with velum CCC achieved adequate treatment, significantly lower than the 48% success rate in patients without CCC.
• Surgical intervention in CCC patients resulted in a 40% adequate treatment rate, outperforming non-surgical management.

Conclusions:

• Patients with OSA, PAP intolerance, and velum CCC have a higher likelihood of treatment failure.
• Surgical intervention demonstrates a potential treatment advantage over continued PAP or oral appliances for velum CCC.
• Further research is warranted to establish optimal treatment strategies for OSA patients with velum CCC.