Impact of Mask Type on Pharyngeal Opening Pressures During Drug-Induced Sleep Endoscopy.

OBJECTIVE

Positive airway pressure applied during drug-induced sleep endoscopy (DISE-PAP) can aid in surgical planning for the management of obstructive sleep apnea (OSA). Studies examining the effect of mask type during DISE-PAP are currently limited. Based on prior literature, we hypothesize that patients undergoing DISE-PAP with nasal masks will experience reduced pharyngeal opening pressures (PhOPs) compared to full-face mask techniques.

METHODS

Adult patients undergoing DISE-PAP with three mask types (nasal, full-face, and full-face masks with mouth closure and teeth in occlusion) from April 2024 to November 2024 were retrospectively reviewed. PhOPs (cmHO) were evaluated by mask type and anatomical location (velum, oropharynx, tongue base, epiglottis). Matched-pairs Friedman tests, unmatched Kruskal-Wallis tests, and multiple comparisons testing were utilized to assess PhOPs. Statistical significance was defined as p < 0.05.

RESULTS

Fifty-six patients met the inclusion criteria. Median PhOP significantly differed for nasal, full-face, and full-face masks with mouth closure and teeth occlusion, respectively, at the velum (6 vs. 10 vs. 7.5 cmHO, p < 0.0001), oropharynx (7.5 vs. 13 vs. 10 cmHO, p < 0.0001), and tongue base (7 vs. 9.5 vs. 7 cmHO, p < 0.0001). Multiple comparisons testing demonstrated reduced median pressures for nasal vs. full-face masks at all sites (p < 0.05) and reduced pressures for full-face masks with mouth closure and teeth occlusion at the velum and oropharynx (p < 0.05).

CONCLUSION

Nasal masks led to reduced PhOP levels compared to full-face masks during DISE-PAP. Further study of DISE-PAP mask techniques is necessary given the recent association of PhOP with patient characteristics and sleep surgery success.