Role of functional and anatomic study in sleep endoscopy for treatment of OSA

OBJECTIVE: To describe a clear and intuitive way to analyse the anatomical meaning of images observed in Drug-induced Sleep Endoscopy (DISE) to fully understand the obstructive dynamics and therefore opt for a tailor-made pharyngeal surgical technique. METHODS: From January 2016 to December 2020, 298 patients who underwent DISE were selected according to inclusion criteria. RESULTS: The case series consisted of 204 males and 94 females with a mean age of 56 years. Body mass index ranged from 19 kg/m(2) to 34 kg/m(2) with a median of 26.5 kg/m(2). Median Apnoea-Hypopnea Index (AHI) was 27 (range 5-62.3). The authors also observed four palate pharyngeal phenotypic patterns of collapse and clarify the morphology and role of the main muscles involved in upper airway collapse. CONCLUSIONS: DISE is fundamental to determine the collapse site in patients affected by obstructive sleep apnoea syndrome. The velopharyngeal region is the most common site of obstruction and lateral pharyngeal wall collapse is the major determining factor. DISE can lead to a deeper understanding of the obstructive dynamic patterns and a more precise identification of the muscle bundles responsible for upper airway collapse.