Polysomnographic airflow shapes and site of collapse during drug-induced sleep endoscopy

Sara Op de Beeck; Daniel Vena; Dwayne Mann; Ali Azarbarzin; Phillip Huyett; Eli Van de Perck; Laura K Gell; Raichel M Alex; Marijke Dieltjens; Marc Willemen; Johan Verbraecken; Andrew Wellman; Olivier M Vanderveken; Scott A Sands

doi:10.1183/13993003.00261-2024

Polysomnographic airflow shapes and site of collapse during drug-induced sleep endoscopy

Eur Respir J. 2024 Mar 28:2400261. doi: 10.1183/13993003.00261-2024. Online ahead of print.

Authors

Sara Op de Beeck^{1

2

3}, Daniel Vena^{4

3}, Dwayne Mann⁵, Ali Azarbarzin⁴, Phillip Huyett⁶, Eli Van de Perck⁷, Laura K Gell⁴, Raichel M Alex⁴, Marijke Dieltjens^{7

2}, Marc Willemen⁸, Johan Verbraecken^{8

9}, Andrew Wellman⁴, Olivier M Vanderveken^{7

2

8}, Scott A Sands⁴

Affiliations

¹ Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium Sara.opdebeeck@uantwerpen.be.
² Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
³ These authors contributed equally to this work.
⁴ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁵ School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
⁶ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
⁷ Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
⁸ Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium.
⁹ Laboratory of Experimental Medicine and Pediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.

PMID: 38548291
DOI: 10.1183/13993003.00261-2024

Abstract

Rationale: Differences in the pharyngeal site-of-collapse influences efficacy of non-CPAP therapies for obstructive sleep apnoea (OSA). Notably, complete concentric collapse at the palate (CCCp) during drug-induced sleep endoscopy (DISE) is associated with reduced efficacy of hypoglossal nerve stimulation, but CCCp is currently not recognisable using polysomnography. Here we develop a means to estimate DISE-based site-of-collapse using overnight polysomnography.

Methods: 182 OSA patients provided DISE and polysomnography data. Six polysomnographic flow-shape characteristics (mean during hypopnoeas) were identified as candidate predictors of CCCp (primary outcome variable, N=44/182), including inspiratory skewness and inspiratory scoopiness. Multivariable logistic regression combined the six characteristics to predict clear presence (N=22) versus absence (N=128) of CCCp (partial collapse and concurrent tongue-base collapse excluded). Odds ratios for actual CCCp between predicted subgroups were quantified after cross-validation. Secondary analyses examined complete lateral wall, tongue-base, or epiglottis collapse. External validation was performed on a separate dataset (N_total=466).

Results: CCCp was characterised by greater scoopiness (β=1.5±0.6 per 2SD, multivariable estimate±se) and skewness (β=11.4±2.4) compared to non-CCCp. Odds ratio [95%CI] for CCCp in predicted positive versus negative subgroups was 5.0[1.9-13.1]. The same characteristics provided significant cross-validated prediction of lateral wall (OR=6.3[2.4-16.5]), tongue-base (3.2[1.4-7.3]), and epiglottis (4.4[1.5-12.4]) collapse. CCCp and lateral wall collapse shared similar characteristics (skewed, scoopy), diametrically opposed to tongue-base and epiglottis collapse characteristics. External validation confirmed model prediction.

Conclusions: The current study provides a means to recognise patients with likely CCCp or other DISE-based site-of-collapse categories using routine polysomnography. Since site-of-collapse influences therapeutic responses, polysomnographic airflow shape analysis could facilitate precision site-specific OSA interventions.