Drug-induced sleep endoscopy: new insights in lateral head rotation compared to lateral head and trunk rotation in (non)positional obstructive sleep apnea patients

Objective: To compare the effect of lateral head rotation to lateral head and trunk rotation on upper airway patency during drug-induced sleep endoscopy (DISE) in nonpositional obstructive sleep apnea (OSA) patients (NPP) and positional OSA patients (PP). Methods: Prospective cohort study. Results: In total 92 patients were included. Seventy-five patients were male (82%) with a mean age of 47.2 ± 11.3 years, a body mass index of 27.0 ± 3.3 kg/m2, and a median apnea–hypopnea index of 16.7 per hour (8.7, 26,5). Of all patients, 75% were PP. Lateral head rotation and lateral head and trunk rotation findings are similar in NPP at each possible level of obstruction, with exception of the oropharynx but not in PP. In PP, lateral head rotation and both lateral head and trunk observations were different at every possible obstruction site. Conclusion: The effect of lateral head rotation and lateral head and trunk rotation on upper airway patency during DISE is significantly different in PP. In NPP, similar results regarding the degree of upper airway obstruction were found at the level of the velum, tongue base, and epiglottis. Level of Evidence: 2b. Laryngoscope, 129:2430–2435, 2019