Lateral epiglottic collapse in obstructive sleep apnea is associated with laterally directed pharyngeal collapse

Study objectives: Epiglottic collapse can obstruct the airway in obstructive sleep apnea (OSA) patients in an anteroposterior (E-ap) or lateral direction (E-lat). The present study investigates the concept that lateral or concentric pharyngeal collapse patterns may remodel the epiglottis and predispose it to lateral collapse. To do so, we hypothesized that the presence of-any form of laterally directed pharyngeal collapse, e.g., oropharyngeal lateral wall collapse (OLW) or complete concentric collapse of the soft palate (CCCp), is associated with increased odds for having concurrent lateral epiglottic collapse.

Methods: We analyzed 582 OSA patients from our drug-induced sleep endoscopy (DISE) cohort. Site of collapse was scored by a single scorer using the VOTE criteria, with epiglottic collapse patients reviewed by 2 additional independent scorers. Logistic regression evaluated the association between presence of laterally directed pharyngeal collapse and the presence of lateral epiglottic collapse.

Results: The overall prevalence of E-lat was 2.6% (n=15). The presence of any form of laterally directed pharyngeal collapse was associated with 4-fold increased odds (4.4 [1.5-12.6], p=0.006) of having concurrent lateral epiglottic collapse. Further, the specific presence of either complete OLW collapse or CCCp was associated with an odds ratio of 3.4 [1.2-9.6] and 8.6 [2.2-33.5], respectively of having concurrent lateral epiglottic collapse.

Conclusions: Greater prevalence of severe laterally directed pharyngeal collapse, in the form of either CCCp or OLW collapse in patients with E-lat supports the concept that laterally and concentric pharyngeal collapse patterns may shape the epiglottis and thereby contribute to the pathogenesis of lateral epiglottic collapse.