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

To describe outcomes in patients with obstructive sleep apnea (OSA) and intolerance of positive airway pressure (PAP) therapy who undergo drug-induced sleep endoscopy (DISE) with findings of complete concentric collapse (CCC) at the velum.

This is a single-institution, retrospective review of all patients undergoing DISE by the senior author between January 2013 and March 2023. Inclusion criteria were moderate to severe OSA, PAP intolerance or failure, and adequate records to determine OSA treatment status.

Six hundred and eighty-nine patients underwent DISE between the above dates. 118 patients (17%) had CCC at the velum, and 103 were included. 23 patients (22%) were successfully treated, while 80 patients (78%) remained inadequately treated. This is significantly lower than the successful treatment rate of 48% at our institution in patients without CCC at the velum (p < 0.0001). Patients with CCC pursuing surgery to either improve PAP compliance, achieve primary surgical cure, or convert to a favorable DISE collapse pattern achieved adequate treatment in 40% of cases (12 of 30, p = 0.006 vs. patients not pursuing surgery). The remainder of CCC patients continued PAP therapy alone, employed a mandibular advancement device, or did not treat their sleep apnea.

Patients with OSA, PAP intolerance, and CCC of the velum on DISE are more likely to remain unsuccessfully treated than those without CCC. Surgical intervention appears to confer a treatment advantage in CCC patients over continued PAP management or oral appliance therapy. Further research is needed to determine the optimal treatment for this patient population.