The Association Between Upper Airway Measures From Computed Tomography and Pharyngeal Manometry Findings During Drug-Induced Sleep Endoscopy (DISE)

Monday, September 30, 2024

9:54 AM – 10:00 AM EDT

Location: MBCC, 238-239

Disclosure(s):

Eric R. Thuler, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Tice R. Harkins, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Raj C. Dedhia, MD, MSCR:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Alan R. Schwartz, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The association between awake upper airway (UA) anatomy and sites of collapse observed during drug-induced sleep endoscopy (DISE) remains unclear in patients with OSA. Pharyngeal manometry permits an objective evaluation of obstruction sites during DISE. Herein, we examined the relationship between awake anatomic measures and objective level of airway collapse on DISE.

Methods: Cross-sectional analysis was performed on prospective PAP alternative patients undergoing CT imaging and DISE PAP titrations with respiratory monitoring and pharyngeal manometry. Two pressure catheters were placed retro-palatal (PUS) and retro-epiglottic (PDS). Nasopalatal collapsibility was defined by the pressure without airflow during nasal PAP titration. Infrapalatal collapsibility was defined by the pressure at the PUS and PDS signals dissociated with increasing respiratory effort. A validated CT analysis protocol was applied blinded to the clinical data. Pearson’s linear and partial correlations were used to explore associations between Pcrit values and CT-based measures.

Results: In total, 62 subjects (75.81% male) were included, mean (SD) age was 57.6 (14.2) years, BMI 29.36 (3.9) kg/m2, and AHI 31.4 (20.6) events/hour. Single-level collapse was nasopalatal in 10 (16%) and infrapalatal in 9 (15%) patients. Multi-level collapse occurred in 43 (69%) patients. Tongue volume was associated with single-level nasopalatal Pcrit (rho = 0.68; p = 0.031), but not with infrapalatal or multiple-level Pcrit (p > 0.05). The correlation remained large after adjustments (rho = 0.6, p = 0.211).

Conclusions: Tongue volume was associated with collapsibility at the nasopalatal area as measured by Pcrit. Our data convey that changes in tongue volume influence retro-palatal collapsibility and multi-level collapse may be secondary to non-anatomical factors. Further work is required to determine the value of tongue volume as a predictor for specific surgical outcomes for OSA.

Presenting Author(s)

Eric R. Thuler, MD, PhD

Adjunct Professor of Sleep Surgery
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Tice R. Harkins, BS

Research Fellow
University of Pennsylvania
Philadelphia, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
ES

Everett G. Seay, RPSGT

Research project Manager
University of Pennsylvania
Philadelphia, PA, United States

Disclosure information not submitted.
AW

Andrew Wiemken, MPH

University of Pennsylvania
Philadelphia, PA, USA

Disclosure information not submitted.
Brendan T. Keenan, MS

Co-Director
Biostatistics Core, Division of Sleep Medicine
Philadelphia, PA, USA

Disclosure information not submitted.
RS

Richard Schwab, MD

Professor of Sleep Medicine
University of Pennsylvania
Philadelphia, Pennsylvania, United States

Disclosure information not submitted.
RD

Raj C. Dedhia, MD, MSCR

Associate Professor of Otorhinolaryngology & Medicine
University of Pennsylvania
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

AS

Alan R. Schwartz, MD

Adjunct Professor
University of Pennsylvania
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.