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Palatal Prolapse on Expiration Predicts Inspiratory Palatal Collapse in Patients with Obstructive Sleep Apnea
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A1244 - Palatal Prolapse on Expiration Predicts Inspiratory Palatal Collapse in Patients with Obstructive Sleep Apnea
Author Block: A. Azarbarzin1, S. A. Sands1, M. Marques1, P. Genta2, L. T. Taranto-Montemurro1, L. Messineo1, D. P. White1, A. Wellman1; 1Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States, 2Pulmonary Division, Heart Institute (InCor), University of São Paulo School of Medicine, Sao Paulo, Brazil.
Rationale: Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction. A number of drug-induced sleep endoscopy (DISE) studies in OSA patients have demonstrated that the upper airway obstruction results from the collapse of one or more pharyngeal structures, such as the soft palate, the lateral pharyngeal walls, the tongue base, and/or the epiglottis. In particular, “isolated” palatal collapse on inspiration is a known predictor of failure to respond to therapies targeting tongue-base obstruction including hypoglossal nerve stimulation and oral appliances; mechanistically, isolated palate collapse is also likely to predict successful outcomes of velopharygeal surgery (UPPP). However, there is currently no non-invasive means to identify such patients. We recently reported that in some individuals, the palate prolapses into the velopharynx during expiration, limiting airflow through the nose or shunting it out the mouth. We hypothesized that this phenomenon is associated with “isolated” palatal collapse on inspiration. We also provide a robust non-invasive means to identify this mechanism of obstruction.
Methods: Using natural sleep endoscopy, 1211 breaths from 22 OSA patients were scored as having or not having palatal expiratory prolapse. The patient-level site of collapse (tongue, isolated palate, pharyngeal lateral walls, and epiglottis) was also characterized. A non-invasive expiratory flow limitation index (EFLI) was developed to detect the presence of palatal prolapse using the flow signal alone.
Results: A cutoff value of EFLI>0.8 detected the presence of palatal prolapse with an accuracy of 95%. The proportion of breaths with palatal prolapse on expiration (PP%>25%) detected isolated palatal collapse on inspiration with a sensitivity and specificity of 86% and93%, respectively.
Conclusions: The current study demonstrates that expiratory palatal prolapse can be detected and quantified non-invasively and predicts the presence of isolated palatal collapse on inspiration. This method may enable clinicians to use clinical data to recognize isolated palatal collapse.
Author Block: A. Azarbarzin1, S. A. Sands1, M. Marques1, P. Genta2, L. T. Taranto-Montemurro1, L. Messineo1, D. P. White1, A. Wellman1; 1Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States, 2Pulmonary Division, Heart Institute (InCor), University of São Paulo School of Medicine, Sao Paulo, Brazil.
Rationale: Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction. A number of drug-induced sleep endoscopy (DISE) studies in OSA patients have demonstrated that the upper airway obstruction results from the collapse of one or more pharyngeal structures, such as the soft palate, the lateral pharyngeal walls, the tongue base, and/or the epiglottis. In particular, “isolated” palatal collapse on inspiration is a known predictor of failure to respond to therapies targeting tongue-base obstruction including hypoglossal nerve stimulation and oral appliances; mechanistically, isolated palate collapse is also likely to predict successful outcomes of velopharygeal surgery (UPPP). However, there is currently no non-invasive means to identify such patients. We recently reported that in some individuals, the palate prolapses into the velopharynx during expiration, limiting airflow through the nose or shunting it out the mouth. We hypothesized that this phenomenon is associated with “isolated” palatal collapse on inspiration. We also provide a robust non-invasive means to identify this mechanism of obstruction.
Methods: Using natural sleep endoscopy, 1211 breaths from 22 OSA patients were scored as having or not having palatal expiratory prolapse. The patient-level site of collapse (tongue, isolated palate, pharyngeal lateral walls, and epiglottis) was also characterized. A non-invasive expiratory flow limitation index (EFLI) was developed to detect the presence of palatal prolapse using the flow signal alone.
Results: A cutoff value of EFLI>0.8 detected the presence of palatal prolapse with an accuracy of 95%. The proportion of breaths with palatal prolapse on expiration (PP%>25%) detected isolated palatal collapse on inspiration with a sensitivity and specificity of 86% and93%, respectively.
Conclusions: The current study demonstrates that expiratory palatal prolapse can be detected and quantified non-invasively and predicts the presence of isolated palatal collapse on inspiration. This method may enable clinicians to use clinical data to recognize isolated palatal collapse.
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