(1306) Common Concurrent Diagnoses on Drug-Induced Sleep Endoscopy Associated With Velum, Oropharyngeal, Tongue base, Epiglottis (VOTE) Score Severity

Introduction: We desired to investigate the effect that common airway findings during drug-induced sleep endoscopy (DISE) have upon VOTE score in a cohort of obstructive sleep apnea (OSA) patients.

Methods: This was a single center retrospective cohort study. Patients who were older than 18 years that underwent DISE at a tertiary care center from July 2016 to July 2022 were included in this analysis. Patient demographics, Epworth Sleepiness Scales (ESS), DISE findings, and VOTE scores were extracted. All statistical analyses were performed using R 4.2.2.

Results: Our cohort included 155 patients (mean age = 61.12 years, SD 11.57; mean BMI = 30.85, SD 6.15). The 6 most common DISE-associated diagnoses during DISEs performed at our center were identified. Diagnoses counts and percentages were as follows: laryngomalacia (n = 60, 38.71%), tonsillar hypertrophy (n = 49, 31.61%), laryngopharyngeal reflux (n = 30, 19.35%), acquired macroglossia (n = 27, 17.42%), turbinate hypertrophy (n = 7, (4.52%), and other nasal cavity obstruction (n = 7, 4.52%). Diagnoses were assessed for association with increased VOTE scores. Laryngomalacia (p = 0.0279) and tonsillar hypertrophy (p = 0.0394) were associated with increased VOTE scores. No other diagnosis was associated with higher VOTE scores.

Conclusions: Common airway findings during DISE may be implicated in overall worse obstruction in OSA patients. Those who suffer from laryngomalacia have an airway predisposed to collapse. Previous literature has shown that those who have tonsillar hypertrophy are more likely to endure velopharyngeal insufficiency (VPI). Interestingly, patients with a post-DISE diagnosis of acquired macroglossia did not have higher VOTE scores compared to the rest of the cohort. This could be due to acquired macroglossia not necessarily resulting in glossoptosis. Therefore, patients with acquired macroglossia may maintain a patent airway without posterior tongue displacement.