Anthropometric Predictors in Drug-Induced Sleep Endoscopy With Positive Airway Pressure

Anthropometric measurements are key risk factors for obstructive sleep apnea (OSA), yet their role as predictors of surgical outcomes in continuous positive airway pressure (CPAP)-intolerant patients remains underexplored. This study examines the relationship between neck, waist, and hip circumferences, airway collapse patterns, and pharyngeal opening pressures (PhOPs) during drug-induced sleep endoscopy with positive airway pressure (DISE-PAP).

Retrospective cohort study.

A single-institution tertiary care center.

Patients with CPAP-intolerant OSA who underwent DISE between December 2023 and April 2024 were identified. Demographics, preoperative sleep studies, anthropometrics, and DISE findings were assessed. Spearman's correlations evaluated associations, with a sub-analysis comparing body roundness index (BRI) to body mass index (BMI).

In total, 73 patients (75.3% male; mean age 59.7; BMI 30.51 kg/m²) were included. Complete concentric collapse of the velum was associated with BMI, BRI, neck, waist, and hip circumferences, and waist:height ratio. Complete collapse at the lateral oropharyngeal wall was associated with BMI and neck and waist circumferences. Males with neck circumferences ≥42 cm had a significantly higher risk of lateral wall collapse (odds ratio [OR] 5.37 [2.03-15.2], P < .001). PhOP correlated with hip circumference (r_s = 0.543, P = .001), neck, waist, and waist-to-height ratio. In patients with BMI < 30, neck circumference correlated with PhOP (r_s = 0.451, P = .046); among males, hip circumference correlated with PhOP (r_s = 0.490, P = .007).

Neck, waist, and hip circumferences predict airway collapse in DISE-PAP, highlighting the role of central adiposity in airway resistance. These findings may inform preoperative assessments and surgical planning for CPAP-intolerant OSA patients.