Phenotypic differences in airway obstruction as determined by VOTE score

Area of Science:

• Sleep Medicine
• Otolaryngology
• Respiratory Medicine

Background:

• Obstructive sleep apnea (OSA) is a common condition characterized by repeated episodes of upper airway collapse during sleep.
• Drug-induced sleep endoscopy (DISE) is a valuable tool for assessing airway obstruction in OSA patients.
• Understanding phenotypic differences in airway obstruction is crucial for tailoring treatment strategies.

Purpose of the Study:

• To investigate phenotypic variations in airway obstruction using VOTE scores in OSA patients undergoing DISE.
• To identify distinct patient clusters based on airway obstruction patterns and demographic factors.

Main Methods:

• Retrospective cohort study of 165 adult patients undergoing DISE.
• Data collected included patient demographics, BMI, AHI, and VOTE scores.
• Spearman correlation and cluster analysis were used to identify relationships and phenotypes.

Main Results:

• Two distinct OSA phenotypes were identified through cluster analysis.
• Phenotype 1: Lower overall VOTE scores, less velum/oropharynx obstruction, more tongue obstruction, and lower BMI.
• Phenotype 2: Worse overall obstruction, increased velum/oropharynx obstruction, and higher BMI.

Conclusions:

• OSA patients can be categorized into two clinically significant phenotypes based on DISE findings.
• Phenotype 1 patients (nonobese, tongue obstruction) may benefit from targeted surgical interventions.
• Phenotype 2 patients (obese, multi-level obstruction) may present greater surgical challenges.