Franklin Andrew S, Putnam Paul M, Chanamolu Meghana C, Nieri Chad A, Gillespie M Boyd
Department of Otolaryngology-Head and Neck Surgery University of Tennessee Health Science Center Memphis Tennessee USA.
Department of Otolaryngology-Head and Neck Surgery Washington University St. Louis Missouri USA.
World J Otorhinolaryngol Head Neck Surg. 2024 Jul 29;11(2):213-219. doi: 10.1002/wjo2.202. eCollection 2025 Jun.
The objective if this study was to investigate phenotypic differences in airway obstruction, as determined by VOTE score, in a cohort of patients with obstructive sleep apnea (OSA) undergoing drug-induced sleep endoscopy (DISE).
Patients older than 18 years of age scheduled for DISE by one surgeon at a tertiary care center from July 2016 to July 2022 were included in a single-center retrospective cohort study. Patient demographics, body mass index (BMI), apnea-hypopnea index (AHI), and VOTE scores were extracted. Spearman correlation tests were utilized to determine the relationship between variables, and statistical analyses were performed using R.
The study included 165 patients (61.24 years, SD 11.57; BMI 31.04 kg/m, SD 6.05). Due to several significant relationships between VOTE scores and patient demographics, a cluster analysis was performed, in which two distinct clusters (phenotype 1 and phenotype 2) arose. Phenotype 1 patients had lower overall VOTE scores ( < 0.001), less obstruction at the velum ( < 0.001) and oropharynx ( < 0.001), significantly more tongue obstruction ( = 0.031), and a significantly lower BMI ( = 0.001). Though not reaching significance, phenotype 1 patients also had more epiglottic obstruction ( = 0.0841) and were older ( = 0.2775).
Patients suffering from OSA may be categorized into one of two distinct phenotypes of clinical significance. Phenotype 1 patients who are nonobese and have less significant obstruction overall, with increased obstruction at the tongue, may benefit greatly from targeted surgical modalities. Conversely, phenotype 2 patients with worse obstruction on DISE and increased velum and oropharynx obstruction may represent a phenotype of OSA that is increasingly difficult to treat surgically, due to body habitus and severe, multi-level obstruction.
本研究的目的是调查在接受药物诱导睡眠内镜检查（DISE）的阻塞性睡眠呼吸暂停（OSA）患者队列中，由VOTE评分确定的气道阻塞的表型差异。
2016年7月至2022年7月在一家三级医疗中心由一名外科医生安排进行DISE的18岁以上患者被纳入一项单中心回顾性队列研究。提取患者人口统计学数据、体重指数（BMI）、呼吸暂停低通气指数（AHI）和VOTE评分。使用Spearman相关性检验来确定变量之间的关系，并使用R进行统计分析。
该研究纳入了165名患者（61.24岁，标准差11.57；BMI 31.04kg/m，标准差6.05）。由于VOTE评分与患者人口统计学数据之间存在若干显著关系，因此进行了聚类分析，其中出现了两个不同的聚类（表型1和表型2）。表型1患者的总体VOTE评分较低（<0.001），软腭（<0.001）和口咽（<0.001）处的阻塞较少，舌阻塞明显更多（=0.031），BMI显著较低（=0.001）。虽然未达到显著水平，但表型1患者的会厌阻塞也更多（=0.0841）且年龄更大（=0.2775）。
患有OSA的患者可能被归类为具有临床意义的两种不同表型之一。非肥胖且总体阻塞不太严重但舌阻塞增加的表型1患者可能会从有针对性的手术方式中受益匪浅。相反，DISE阻塞更严重且软腭和口咽阻塞增加的表型2患者可能代表了一种OSA表型，由于体型和严重的多平面阻塞，手术治疗越来越困难。
