The role of positional changes in optimizing OSA treatment: evidence from DISE

Area of Science:

• Sleep Medicine
• Otolaryngology
• Respiratory Physiology

Background:

• Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurrent upper airway collapse.
• Positional therapy is a non-invasive approach to manage OSA, but its efficacy varies.
• Understanding specific airway obstruction patterns related to body position is crucial for optimizing treatment.

Purpose of the Study:

• To evaluate the impact of positional changes on upper airway obstruction during drug-induced sleep endoscopy (DISE).
• To identify airway regions most affected by positional changes in patients with OSA.
• To specifically assess the tongue base's response to positional alterations in OSA.

Main Methods:

• Prospective study involving 186 patients with OSA from June 2021 to June 2024.
• Drug-induced sleep endoscopy (DISE) was performed in both supine and lateral positions.
• Airway obstruction patterns were classified using the VOTE (Velopharynx, Oropharynx, Tongue base, Epiglottis) system.

Main Results:

• In the supine position, significant obstructions were observed at the soft palate (88.2%), tongue base (53.2%), and oropharynx (33.3%).
• Lateral positioning markedly reduced obstructions, with 94.9% of tongue base obstructions resolving.
• The reduction in tongue base obstruction with lateral positioning was statistically significant compared to other airway sites (p < 0.001).

Conclusions:

• DISE effectively identifies airway regions responsive to positional changes, aiding in the selection of positional therapy.
• Lateral positioning demonstrates a significant benefit in reducing tongue base obstruction, a key factor in OSA.
• These findings suggest positional therapy is a viable, non-invasive treatment option for OSA patients with specific obstruction patterns, warranting further long-term efficacy studies.