Schudt Dalila Mota, Jacomelli Marcia, Ohannesian Victor Arthur, Gregório Marcelo Gervilla, Palomino Addy Lidvina Mejia, da Silva Costa Altair
Department of Otorhinolaryngology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Center for Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Eur Arch Otorhinolaryngol. 2025 Jun 4. doi: 10.1007/s00405-025-09499-2.
This study evaluated the impact of Body Mass Index (BMI) on upper airway obstruction severity in Obstructive Sleep Apnea (OSA) patients using sleep endoscopy.
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.
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).
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.
本研究使用睡眠内镜评估体重指数（BMI）对阻塞性睡眠呼吸暂停（OSA）患者上气道阻塞严重程度的影响。
对接受丙泊酚镇静睡眠内镜检查的OSA患者进行回顾性分析。使用VOTE方案对阻塞模式进行分类，分析塌陷位置、类型和严重程度。患者按BMI分组：正常、超重和肥胖。还分析了年龄和性别的影响。
分析了210例患者（男性占72.9%，平均年龄45.1±11.1岁，平均BMI 27.06±3.91）。腭咽是最常受影响的部位（74.8%），其次是舌根（60%）、会厌（55%）和口咽（40.5%）。舌根处前后塌陷占主导（91.4%），而口咽处侧方塌陷最为常见（68.1%）。肥胖患者在腭咽（p = 0.023）、口咽（p < 0.001）和多平面阻塞（p = 0.049）方面的完全阻塞发生率显著更高。在VOTE分类中观察到显著的性别差异，男性表现出更多的环形、侧方和多平面塌陷。女性在腭咽与会厌处有更多的前后塌陷。完全阻塞在年龄≥45岁的患者中更为普遍，尤其是在舌根处（p = 0.007）。
腭咽是OSA患者的主要阻塞部位。BMI、性别和年龄显著影响气道塌陷模式，肥胖患者表现出多平面和完全阻塞增加。这些发现支持使用睡眠内镜进行个性化的OSA管理。
