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

Abstract

Objective: To evaluate potential insights gained from incorporating ventilatory measures during drug induced sleep endoscopy (DISE) as a model of obstructive sleep apnea (OSA).

Study design: Cross-sectional SETTING: Emory University Hospital Midtown METHODS: DISE was performed on OSA patients referred for presurgical evaluation. A CPAP titration was performed under DISE to determine the critical closing pressure (P_crit) and the pharyngeal opening pressure (P_open) of the upper airway. Airflow was captured using a calibrated pneumotachometer and allowed for calculation of the following ventilatory measures: peak airflow (V_max), tidal volume (TV), respiratory rate (RR) and minute ventilation (MV). Comparative analysis was performed exploring differences in ventilatory measures and baseline demographics between high collapsible and low collapsible airways based on a median split of P_open.

Results: Between 6/1/2022 and 6/30/2023, 36 patients were enrolled with 31 completing the study. Between the start and completion of DISE CPAP titration, there was a significant improvement in V_max (+16 L/min, [12, 20], p<0.001), TV (+0.29 L, [0.20, 0.37], p<0.001), and MV (4.4 L/min, [3.2, 5.5], p<0.001), while RR was not significantly different (-0.31 breaths/min, [-0.96, 0.35], p=0.3). High P_open patients exhibited significantly greater V_max (35.48 L/min (13.91) vs. 22.24 L/min (7.22), p=0.003) and were younger (55.94 yrs (10.59) vs. 68.87 yrs (8.52), p<0.001).

Conclusion: Incorporating quantitative ventilatory measures into DISE provides valuable insights into individualized patterns of airway collapsibility and OSA pathophysiology. This could allow for more targeted approaches to further research and eventually improve management of the disorder.