Nonresponders to pharyngeal surgery for obstructive sleep apnea: Insights from drug‐induced sleep endoscopy
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Objectives/Hypothesis: To examine drug‐induced sleep endoscopy (DISE) findings in nonresponders to previous pharyngeal obstructive sleep apnea (OSA) surgery. Study Design: Cross‐sectional. Methods: DISE using propofol for unconscious sedation was performed in nonresponders to previous OSA surgery (including palate surgery with or without tonsillectomy and possible other procedures). Nonresponders were defined as subjects with a postoperative apnea‐hypopnea index more than 10 events/hr. Recorded findings from DISE included the presence and degree of obstruction in the palatal and hypopharyngeal regions, the contributions of specific structures (velum, oropharyngeal lateral walls, tongue, and/or epiglottis) to upper airway obstruction, and the degree of mouth opening. Results: Thirty‐three nonresponders underwent DISE examinations. Age was 46.2 ± 11.8 years, and 9% (3 of 33) were female. On diagnostic sleep studies prior to DISE, the apnea–hypopnea index was 43.4 ± 26.6 events/hr. During DISE, a majority of subjects demonstrated residual palatal obstruction, and almost all demonstrated hypopharyngeal obstruction. A diversity of individual structures contributed to upper airway obstruction, often in combination. Moderate to severe mouth opening occurred in one‐third of subjects and was associated with narrowing of upper airway dimensions. Conclusions: Residual upper airway obstruction in surgery nonresponders likely occurs due to multiple mechanisms, and DISE may enhance the understanding of them.
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The limited success of single-level UPPP was attributed to persistent retropalatal collapse and untreated additional obstruction sites.
“This was found to be due to persistent retropalatal collapse but also untreated additional sites of obstruction.1643,1914”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1914]
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- Authors
- Kezirian, E. J.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Kezirian, Eric J.
- ORCID
- Kezirian, Eric J.
- Venue
- The Laryngoscope
- Publisher
- Wiley
- Published
- 2011-05-06
- Volume
- 121
- Issue
- 6
- Pages
- 1320-1326
- ISSN
- 0023-852X (ISSN-L)
- 1531-4995
- PMC
- PMC3100447
- OpenAlex
- W1974054864
- Semantic Scholar
- 60e8d6750d2748d3bcb8703e1c62ed022ed4aaf5
- Cited by
- 129
- References
- 43
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 2 · 2023: 8 · 2022: 10 · 2021: 12 · 2020: 7 · 2019: 8 · 2018: 8 · 2017: 18 · 2016: 7 · 2015: 10 · 2014: 11 · 2013: 5 · 2012: 10
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Laryngoscope (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (L30 HL078367)
- National Center for Research Resources (KL2RR024130)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- obstructive sleep apnea, drug-induced sleep endoscopy, pharyngeal surgery, hypopharyngeal obstruction, mouth opening, apnea-hypopnea index, tonsillectomy, palatal surgery
- MeSH terms
- Adult, Aged, Airway Obstruction, Endoscopy, Female, Humans, Male, Middle Aged, Pharynx, Retrospective Studies, Sleep, Propofol, Procedural Sedation, Polysomnography, Anesthetics, Intravenous, Sleep Apnea, Obstructive
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