USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles.
Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles.
JAMA Otolaryngol Head Neck Surg. 2019 Feb 1;145(2):159-165. doi: 10.1001/jamaoto.2018.3692.
The anatomic mechanisms underlying positional vs nonpositional obstructive sleep apnea (OSA) are poorly understood and may inform treatment decisions.
To examine drug-induced sleep endoscopy (DISE) findings in the supine vs nonsupine body positions in positional and nonpositional obstructive sleep apnea.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of 65 consecutive eligible adults with OSA undergoing DISE without marked tonsillar hypertrophy, including 39 with positional OSA (POSA) and 26 with nonpositional OSA (N-POSA) was conducted in a sleep surgery practice at a tertiary academic medical center.
Drug-induced sleep endoscopy performed in the supine vs nonsupine body position.
Drug-induced sleep endoscopy findings were scored separately for the supine and lateral body positions using the VOTE classification (velum, oroparyngeal lateral walls, tongue, epiglotis) and with identification of a single primary structure contributing to airway obstruction. Velum-related obstruction was separated into anteroposterior and lateral components.
The 65 study participants had a mean (SD) age of 52.4 (11.7) years, and 55 (84.6) were men. Mean (SD) body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) was 27.2 (3.1), with only 9 (14%) of 65 participants having a BMI greater than 30. The supine body position was associated with greater odds of anteroposterior velum- (odds ratio [OR], 7.28; 95% CI, 3.53-15.01), tongue- (OR, 29.4; 95% CI, 12.1-71.5), and epiglottis-related (OR, 11.0; 95% CI, 1.3-92.7) obstruction in the entire cohort, with similar findings in the POSA and N-POSA subgroups. The supine body position was associated with a lower odds of oropharyngeal lateral wall-related (OR, 0.22; 95% CI, 0.07-0.70) obstruction in the N-POSA subgroup, whereas there was no increase in the overall sample or the POSA subgroup. The oropharyngeal lateral walls were a common primary structure causing obstruction, especially in the lateral body position.
In a study population of primarily nonobese adults, DISE findings differed based on body position, generally corresponding to gravitational factors. Treatments that address velum- and tongue-related obstruction successfully may be more effective in the POSA population.
体位性与非体位性阻塞性睡眠呼吸暂停（OSA）的解剖学机制尚不清楚，可能为治疗决策提供信息。
在体位性和非体位性阻塞性睡眠呼吸暂停中，检查仰卧位与非仰卧位时药物诱导睡眠内镜（DISE）的发现。
设计、设置和参与者：在一家三级学术医疗中心的睡眠外科诊所，对 65 名连续符合条件的患有 OSA 的成年人进行了横断面研究，这些成年人在没有明显扁桃体肥大的情况下接受了 DISE 检查，其中 39 名患有体位性 OSA（POSA），26 名患有非体位性 OSA（N-POSA）。
仰卧位与非仰卧位时进行药物诱导睡眠内镜检查。
使用 VOTE 分类（悬雍垂、口咽侧壁、舌、会厌）分别对仰卧位和侧卧位的药物诱导睡眠内镜检查结果进行评分，并确定导致气道阻塞的单一主要结构。悬雍垂相关的阻塞分为前后和侧向两部分。
65 名研究参与者的平均（SD）年龄为 52.4（11.7）岁，其中 55 名（84.6%）为男性。平均（SD）体重指数（BMI，体重以千克为单位除以身高以米为单位的平方）为 27.2（3.1），仅 9 名（14%）参与者的 BMI 大于 30。仰卧位与更大的悬雍垂前-后（比值比 [OR]，7.28；95%置信区间 [CI]，3.53-15.01）、舌（OR，29.4；95% CI，12.1-71.5）和会厌相关（OR，11.0；95% CI，1.3-92.7）阻塞的可能性相关，在 POSA 和 N-POSA 亚组中也有类似的发现。仰卧位与非 POSA 亚组中口咽侧壁相关（OR，0.22；95% CI，0.07-0.70）阻塞的可能性降低，但在总样本或 POSA 亚组中没有增加。口咽侧壁是引起阻塞的常见主要结构，尤其是在侧卧位。
在主要为非肥胖成年人的研究人群中，DISE 发现因体位而异，通常与重力因素相对应。针对悬雍垂和舌相关阻塞的治疗方法在 POSA 人群中可能更有效。
