Sleep endoscopy in obstructive sleep apnea: analysis of pharyngeal collapse patterns and correlation with body mass index.

Objective: This study evaluated the impact of Body Mass Index (BMI) on upper airway obstruction severity in Obstructive Sleep Apnea (OSA) patients using sleep endoscopy.

Method: Retrospective analysis of OSA patients undergoing propofol-sedated sleep endoscopy. Obstruction patterns were classified using the VOTE protocol, analyzing collapse location, type, and severity. Patients were grouped by BMI: normal, overweight, and obese. The influence of age and gender was also analyzed.

Results: 210 patients (72.9% male, mean age 45.1 ± 11.1 years, mean BMI 27.06 ± 3.91) were analyzed. The velopharynx was the most frequently affected site (74.8%), followed by the tongue base (60%), epiglottis (55%), and oropharynx (40.5%). Anteroposterior collapse predominated at the tongue base (91.4%), while lateral collapse was most common in the oropharynx (68.1%). Obese patients had significantly higher rates of complete obstruction in the velopharynx (p = 0.023), oropharynx (p < 0.001), and multilevel obstruction (p = 0.049). Significant gender differences were observed in VOTE classification, with males exhibiting more circumferential, lateral, and multilevel collapses. Females had more anteroposterior collapse in the velopharynx and epiglottis. Complete obstruction was more prevalent in patients aged ≥ 45 years, particularly at the tongue base (p = 0.007).

Conclusion: The velopharynx was the primary obstruction site in OSA patients. BMI, gender, and age significantly influenced airway collapse patterns, with obese patients demonstrating increased multilevel and complete obstruction. These findings support sleep endoscopy for personalized OSA management.