Race-Based Differences in Velopharyngeal Collapse Patterns During Drug-Induced Sleep Endoscopy

To investigate race-based differences in upper-airway collapse patterns during drug-induced sleep endoscopy (DISE) and assess their potential contribution to disparities in hypoglossal nerve stimulation (HGNS) eligibility among black patients with obstructive sleep apnea (OSA).

Retrospective cohort study.

Academic tertiary care center.

Adult patients with OSA who underwent DISE were included. Procedures were performed using a standardized propofol protocol and scored using the Velum, Oropharynx, Tongue base, Epiglottis (VOTE) classification. Patients self-identifying as black or white were analyzed. Demographic, anthropometric, and polysomnographic data were compared using t tests and chi-squared analyses. Logistic regression was performed to determine whether race was independently associated with anterior-posterior (AP) velum collapse after adjusting for covariates.

Ninety patients were analyzed (black: n = 20; white: n = 70). Groups were similar in age, sex, body mass index, apnea-hypopnea index, and neck circumference. AP collapse was significantly less common among black than white patients (40% vs 71%, P = .02). In multivariable modeling adjusting for age, sex, body mass index, neck circumference, and pharyngeal opening pressure, black race remained an independently negatively associated with AP collapse (odds ratio 0.09, 95% CI [0.02-0.40], P < .01).

Black patients were significantly less likely than white patients to exhibit AP velum collapse on DISE, potentially limiting eligibility for HGNS therapy. These findings suggest that racial differences in upper-airway physiology may contribute to disparities in access to surgical treatment for OSA and underscore the need for therapies addressing non-AP collapse phenotypes.