Predicting epiglottic collapse in patients with obstructive sleep apnea

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915305/

Abstract
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.


Interesting article, with epiglottic collapse and non-collapse videos synchronized to flow patterns.

yrnkrn wrote: ↑

Wed Apr 17, 2019 1:31 am

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915305/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915321/

Has your research of epiglottic collapse revealed a treatment differing from that used for other types of obstructive events, that is, other than cpap? Has your research indicated that cpap is not effective in treating epiglottic collapse?

These are about two different obstruction locations that has in common a feature, when losing muscle tone function they like a one-way valve.
Palatal prolapse will block exhale.
Epiglottic collapse will block inhale.
Pushing harder (more pressure) on a one-way valve will only shut it more, so CPAP is not effective for "opening" the valve.
CPAP does help inflating the area around the valve, possibly avoiding getting into the one-way situation in the first place.
I believe that really solving these "one-way valve" situations require additional solutions.
For the epiglottis, surgery.
For the palate, UPPP, the Pillar procedure or a stent that goes though the nose such as http://www.alaxo.com/alaxostent_eng.html.
CPAP may be still required for the other "regular" collapse sites.
Luckily these kind of obstructions are rare as the main obstruction reason so CPAP is certainly the best all-around first line obstruction event solver.