Analysis of the influence of head rotation during drug-induced sleep endoscopy in obstructive sleep apnea.

Objectives/hypothesis: Currently, drug-induced sleep endoscopy (DISE) in obstructive sleep apnea (OSA) is predominantly performed in supine position. When positional therapy (avoidance of supine sleeping position in positional OSA (POSA) is implemented as (part of the) treatment, one should assess levels of obstruction in the other sleeping positions. Therefore, the current study examined the influence of difference head positions during DISE in patients with OSA and POSA.

Study Design: Consecutive prospective study.

Methods: DISE was performed in patients with an apnea hypopnea index at baseline polysomnography greater than 5 events/h. The upper airway was assessed at velum, oropharynx, tongue base, and epiglottis level in supine position. The patients head were then tilted to the left and the right side and the DISE findings were recorded.

Results: One hundred consecutive patients were included. In positional apneics (n = 67), lateral position was associated with decreased frequency of complete anteroposterior collapse at velum (P < 0.01), tongue base (P < 0.01), and epiglottis (P < 0.01) level-and increased frequency of partial anteroposterior collapse at velum (P < 0.01), tongue base (P < 0.01), and epiglottis (P <0.05) level in comparison with supine position. DISE findings showed no difference between the right and left position, whereas findings after head rotation were significantly different in comparison with the supine position.

Conclusions: Head rotation improves upper airway collapse during DISE in supine position. This improvement of upper airway patency is more predominant in POSA patients.