Predicting epiglottic collapse in patients with obstructive sleep apnoea
Sands, Scott A.
de Beeck, Sara Op
Genta, Pedro R.
de Melo, Camila M. [UNIFESP]
Vanderveken, Olivier M.
White, David P.
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Obstructive sleep apnoea (OSA) is characterised by pharyngeal obstruction occurring at different sites. Endoscopic studies reveal that epiglottic collapse renders patients at higher risk of failed oral appliance therapy or accentuated collapse on continuous positive airway pressure. Diagnosing epiglottic collapse currently requires invasive studies (imaging and endoscopy). As an alternative, we propose that epiglottic collapse can be detected from the distinct airflow patterns it produces during sleep. 23 OSA patients underwent natural sleep endoscopy. 1232 breaths were scored as epiglottic/nonepiglottic collapse. Several flow characteristics were determined from the flow signal (recorded simultaneously with endoscopy) and used to build a predictive model to distinguish epiglottic from nonepiglottic collapse. Additionally, 10 OSA patients were studied to validate the pneumotachograph flow features using nasal pressure signals. Epiglottic collapse was characterised by a rapid fall(s) in the inspiratory flow, more variable inspiratory and expiratory flow and reduced tidal volume. The cross-validated accuracy was 84%. Predictive features obtained from pneumotachograph flow and nasal pressure were strongly correlated. This study demonstrates that epiglottic collapse can be identified from the airflow signal measured during a sleep study. This method may enable clinicians to use clinically collected data to characterise underlying physiology and improve treatment decisions.
CitationEuropean Respiratory Journal. Sheffield, v. 50, n. 3, p. -, 2017.
SponsorshipOMPA Corporation, Kaifeng, China
Philips Respironics research grant
National Institutes of Health (NIH)
Harvard Catalyst Clinical Research Center (HCCRC)
Natural Sciences and Engineering Research Council of Canada (NSERC)
National Health and Medical Research Council of Australia (NHMRC)
American Heart Association (AHA)
American Thoracic Society Foundation
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
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