(1301) A Systematic Review of Imaging Modalities for Diagnosis and Surgical Planning of Obstructive Sleep Apnea

Introduction: Diagnosis of obstructive sleep apnea (OSA) is essential for effective treatment and prevention of related comorbidities. This systematic review evaluates the effectiveness of imaging modalities in diagnosing and choosing treatment methods for OSA. The gold standard diagnostic test is polysomnography (PSG), although home testing is an alternative. Drug-induced sleep endoscopy (DISE) is used to identify the location of dynamic obstruction when considering surgery or evaluating treatment failure. The 2022 International Consensus Statement on OSA advised against routine imaging for diagnosing OSA, though it may be helpful in surgical planning.

Methods: A systematic search across PubMed, Scopus, and Embase yielded 56 studies on various imaging modalities in children and adults, including 5 studies on non-contact sleep assessment technologies (infrared optical gas imaging, impulse radio ultra-wideband radar sensors, infrared thermography, and actigraphy), 15 studies on lateral cephalometry, 3 on cone-beam CT (CB-CT), 6 on dynamic CT, 18 on dynamic and static MRI, and 9 on ultrasonography. Each modality was examined for its potential as a diagnostic and surgical planning tool.

Results: Lateral cephalometry shows utility in identifying patients likely to have success with hypoglossal nerve stimulator, but overall, both cephalometry and CB-CT are less useful for diagnosis or surgical planning. Dynamic CT and MRI are effective in airway evaluation but are costly and logistically challenging, lacking evidence for use in diagnosis. Their superiority over DISE remains unproven in determining location of obstruction for surgical planning. Awake ultrasound, inexpensive and safe, may emerge as a screening tool for OSA.

Conclusions: PSG remains the gold standard for diagnosis, and various non-contact sleep assessment tools may enhance this tool. Dynamic MRI offers insight, especially in surgical planning by accurately identifying areas of obstruction, but studies are needed to assess its cost-effectiveness, while ultrasound holds promise in emerging as a screening modality.