Tongue Grooving During Drug-Induced Sleep Endoscopy: A Novel Tool to Evaluate the Airway

Posterior tongue grooving (PTG) is a well-documented morphologic change in tongue shape. Drug-induced sleep endoscopy (DISE) reveals variable degrees of posterior tongue grooving at the oropalatal junction. To elucidate our understanding of posterior tongue grooving, a retrospective study of its prevalence, demographics, and anatomic associations was performed.

Retrospective cohort study.

Single Institution.

71 patients were retrospectively reviewed after adult DISE from 2018 to 2021. Velum, oropharynx, tongue, and epiglottis (VOTE) collapse patterns, demographics, and sleep study variables were analyzed. Patients with previous upper airway surgery were excluded. Posterior tongue grooving was scored 1+ to 4+ with higher values indicating a greater groove. A linear regression analysis investigated the relationship between tongue grooving and oropharyngeal lateral wall collapse.

Mean Apnea-Hypopnea Index was 35.7 [IQR: 34.1-37.4] events/hour and mean body mass index (BMI) was 30.7 [30.3-31.2] kg/m². Of 71 patients, 36% were 1+, 16.6% were 2+, 29.1% were 3+, and 18% were 4+. Increased grade of posterior tongue grooving was significantly associated with decreased levels of lateral oropharyngeal wall collapse (P < .03). BMI was positively correlated with increased oropharyngeal lateral wall collapse (P = .04).

Tongue grooving is a variable morphologic finding observed during DISE. This study associates high tongue grooving scores with significantly lesser degrees of lateral oropharyngeal wall collapse, suggesting that posterior tongue grooving may serve as a surrogate for pharyngeal muscle tone during DISE. Further randomized, prospective research is warranted to uncover the etiology and physiologic significance of this phenomenon.