Using DISE to characterize upper airway collapse and ventilatory characteristics in modeling obstructive sleep apnea

Area of Science:

• Sleep Medicine
• Respiratory Physiology
• Otolaryngology

Background:

• Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway collapse during sleep.
• Drug-induced sleep endoscopy (DISE) is a valuable tool for evaluating airway anatomy and collapsibility in OSA.
• Current DISE protocols may not fully capture dynamic airway behavior during sleep.

Purpose of the Study:

• To investigate the utility of integrating quantitative ventilatory measures into DISE.
• To model obstructive sleep apnea (OSA) pathophysiology by assessing airway collapsibility during DISE.
• To explore potential insights into individualized airway dynamics and OSA mechanisms.

Main Methods:

• A cross-sectional study was conducted at Emory University Hospital Midtown.
• Patients with OSA underwent DISE with concurrent CPAP titration to determine critical closing pressure (P_crit) and pharyngeal opening pressure (P_open).
• Ventilatory measures including peak airflow (V_max), tidal volume (TV), respiratory rate (RR), and minute ventilation (MV) were calculated from airflow data.

Main Results:

• Significant improvements in V_max, TV, and MV were observed during DISE CPAP titration.
• Patients with higher pharyngeal opening pressure (indicating more collapsible airways) were younger and had higher peak airflow.
• Comparative analysis revealed significant differences in ventilatory measures between high and low airway collapsibility groups.

Conclusions:

• Integrating quantitative ventilatory measures into DISE provides valuable, individualized insights into airway collapsibility.
• This approach enhances understanding of OSA pathophysiology.
• Findings suggest potential for more targeted research and improved clinical management of OSA.