Positive airway pressure–associated epiglottis-related obstruction in adult men with obstructive sleep apnea

To characterize changes in ventilation and inspiratory airflow associated with visual evidence of epiglottis-related obstruction during drug-induced sleep endoscopy (DISE) with positive airway pressure (PAP) administration among adults with obstructive sleep apnea (OSA).

This was a case–control study of adults with OSA undergoing DISE with measurement of airflow and mask pressure, prior to and during PAP administration. Cases were defined by visual evidence of partial or complete epiglottis-related obstruction, whether prior to and/or with PAP. Each case was matched to a control with an identical visual obstruction pattern (other than for the epiglottis) prior to PAP (if available), with attempted matching on age and BMI. For each breath, ventilation and mean inspiratory airflow were calculated, along with the endoscopic degree of visual epiglottis-related obstruction.

From 150 study participants, 26 cases with 2050 breaths and 14 matched controls with 1353 breaths were selected. With increasing PAP level and mask pressure, 19 cases (13% of total study participants) had some decrease in ventilation or mean inspiratory airflow. Increasing mask pressure was associated with increased ventilation and mean inspiratory airflow in controls at all pressures and in cases before the onset of visual epiglottis-related obstruction. Among cases, once visual epiglottis-related obstruction emerged, increasing mask pressure was associated with decreasing ventilation and mean inspiratory airflow relative to the pattern in controls and cases at lesser mask pressures.

Visual epiglottis-related obstruction during DISE with PAP occurs in some individuals that limits increases in ventilation and mean inspiratory airflow normally seen with increases in PAP levels.