Tschopp Samuel, Borner Urs, Caversaccio Marco, Tschopp Kurt
Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital University of Bern Bern Switzerland.
Department of Otorhinolaryngology-Head and Neck Surgery Kantonsspital Baselland Liestal Switzerland.
OTO Open. 2025 Mar 20;9(1):e70099. doi: 10.1002/oto2.70099. eCollection 2025 Jan-Mar.
Patients undergo a drug-induced sleep endoscopy before unilateral hypoglossal nerve stimulation. This study aims to reduce the need for preoperative drug-induced sleep endoscopy by predicting favorable collapse patterns at the velum based on clinical examination and sleep study data.
A retrospective cohort study.
A single-center trial.
Drug-induced sleep endoscopy recordings were scored by a blinded rater, and the palatal collapse pattern was classified as favorable (no or anterior-posterior) or unfavorable (lateral or concentric), irrespective of collapse degree. Logistic regression models were constructed using clinical examination and sleep data to predict palatal collapse patterns. Model performance was assessed using receiver-operating characteristic curves and validated internally using bootstrapping and externally using a separate cohort.
Recordings of 250 patients were analyzed, of which 118 showed a favorable palatal collapse pattern. Lower body mass index (BMI), lower tonsil grade, and less intense bed-partner-reported snoring were significant predictors of favorable collapse patterns (area under the curve [AUC] 0.70). A further reduction in tonsil grade and BMI resulted in similar model performance (AUC 0.68). In patients with no tonsils and BMI < 28 kg/m or tonsil grade 1 and BMI < 24 kg/m, a favorable collapse was correctly predicted in 81%. In external validation, favorable collapse was correctly identified in 91%.
Favorable palatal collapse can accurately be predicted in patients with small or absent tonsils and low BMI. Before unilateral hypoglossal nerve stimulation implantation, a drug-induced sleep endoscopy might not be necessary in this subset of patients.
患者在接受单侧舌下神经刺激之前需进行药物诱导睡眠内镜检查。本研究旨在通过基于临床检查和睡眠研究数据预测软腭的良好塌陷模式，以减少术前药物诱导睡眠内镜检查的需求。
一项回顾性队列研究。
单中心试验。
由一名不知情的评分者对药物诱导睡眠内镜检查记录进行评分，软腭塌陷模式被分类为良好（无或前后向）或不良（侧向或同心向），而不考虑塌陷程度。使用临床检查和睡眠数据构建逻辑回归模型，以预测软腭塌陷模式。使用受试者工作特征曲线评估模型性能，并通过自举法进行内部验证，通过一个单独的队列进行外部验证。
分析了250例患者的记录，其中118例显示出良好的软腭塌陷模式。较低的体重指数（BMI）、较低的扁桃体分级以及床伴报告的打鼾程度较轻是良好塌陷模式的显著预测因素（曲线下面积[AUC]为0.70）。扁桃体分级和BMI的进一步降低导致类似的模型性能（AUC为0.68）。在无扁桃体且BMI < 28 kg/m²或扁桃体分级为1且BMI < 24 kg/m²的患者中，81%的患者被正确预测为良好塌陷。在外部验证中，91%的患者被正确识别为良好塌陷。
对于扁桃体小或无扁桃体且BMI低的患者，可以准确预测其软腭的良好塌陷。在单侧舌下神经刺激植入之前，这部分患者可能无需进行药物诱导睡眠内镜检查。
