Impact of Mask Type on Pharyngeal Opening Pressures During Drug-Induced Sleep Endoscopy

Positive airway pressure applied during drug-induced sleep endoscopy (DISE-PAP) can aid in surgical planning for the management of obstructive sleep apnea (OSA). Studies examining the effect of mask type during DISE-PAP are currently limited. Based on prior literature, we hypothesize that patients undergoing DISE-PAP with nasal masks will experience reduced pharyngeal opening pressures (PhOPs) compared to full-face mask techniques.

Adult patients undergoing DISE-PAP with three mask types (nasal, full-face, and full-face masks with mouth closure and teeth in occlusion) from April 2024 to November 2024 were retrospectively reviewed. PhOPs (cmH₂O) were evaluated by mask type and anatomical location (velum, oropharynx, tongue base, epiglottis). Matched-pairs Friedman tests, unmatched Kruskal-Wallis tests, and multiple comparisons testing were utilized to assess PhOPs. Statistical significance was defined as p < 0.05.

Fifty-six patients met the inclusion criteria. Median PhOP significantly differed for nasal, full-face, and full-face masks with mouth closure and teeth occlusion, respectively, at the velum (6 vs. 10 vs. 7.5 cmH₂O, p < 0.0001), oropharynx (7.5 vs. 13 vs. 10 cmH₂O, p < 0.0001), and tongue base (7 vs. 9.5 vs. 7 cmH₂O, p < 0.0001). Multiple comparisons testing demonstrated reduced median pressures for nasal vs. full-face masks at all sites (p < 0.05) and reduced pressures for full-face masks with mouth closure and teeth occlusion at the velum and oropharynx (p < 0.05).

Nasal masks led to reduced PhOP levels compared to full-face masks during DISE-PAP. Further study of DISE-PAP mask techniques is necessary given the recent association of PhOP with patient characteristics and sleep surgery success.