Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse.
<h4>Purpose</h4>Head rotation is thought to have an effect on obstructive sleep apnea (OSA) severity. However, keeping the head rotated fully during sleep is difficult to maintain, and the effect of head rotation is not the same in all OSA patients. Thus, this study aimed to identify whe...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0268455 |
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| author | Shi Nee Tan Jong-Min Kim Jisun Kim Chung Man Sung Hong Chan Kim Jongho Lee Sang Chul Lim David P White Hyung Chae Yang D Andrew Wellman |
| author_facet | Shi Nee Tan Jong-Min Kim Jisun Kim Chung Man Sung Hong Chan Kim Jongho Lee Sang Chul Lim David P White Hyung Chae Yang D Andrew Wellman |
| author_sort | Shi Nee Tan |
| collection | DOAJ |
| description | <h4>Purpose</h4>Head rotation is thought to have an effect on obstructive sleep apnea (OSA) severity. However, keeping the head rotated fully during sleep is difficult to maintain, and the effect of head rotation is not the same in all OSA patients. Thus, this study aimed to identify whether less head rotation has an effect on airway patency and determine the responder characteristics to the head rotation maneuver (HRM).<h4>Methods</h4>We recruited 221 patients who underwent overnight polysomnography and drug-induced sleep endoscopy (DISE) in a tertiary hospital from June 2019 to July 2020. Airway patency and the site of airway collapse were determined in the supine position with the head at 0, 30, and 60 degrees of rotation (HRM0°, HRM30°, and HRM60°, respectively) during DISE. The site of collapse was determined using the VOTE classification system: the velum (palate), oropharyngeal lateral walls, tongue base, and epiglottis. Each structure was labeled as 0, 1, or 2 (patent, partially obstructed, and completely obstructed, respectively). Airway response to the HRM30° and 60° and the clinical characteristics associated with airway opening were analyzed.<h4>Results</h4>The study population had a median age of 52 (25-61) years, a body mass index of 26.7(24.6-29.4) kg/m2, and the apnea-hypopnea index (AHI) of 28.2(13.7-71.9) events/h. HRM influenced airway patency positively not only with HRM60° (p<0.001) but also following limited rotation (HRM30°, p<0.001). Patients with tongue base (40.0% with HRM 60°) and epiglottic (52.6% with HRM 60°) collapse responded particularly well to HRM. Multivariate analysis revealed that lower AHI (p<0.001) and an absence of oropharyngeal lateral walls collapse (p = 0.011) were significant predictors of responders to HRM.<h4>Conclusion</h4>Head rotation improved airway obstruction in OSA patients, even with a small degree of rotation, and should be further explored as a potential form of therapy in appropriately selected patients. |
| first_indexed | 2024-12-12T00:40:45Z |
| format | Article |
| id | doaj.art-27cad44d5a7a4bb997d730eb5d4e1275 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-12T00:40:45Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-27cad44d5a7a4bb997d730eb5d4e12752022-12-22T00:44:14ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01175e026845510.1371/journal.pone.0268455Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse.Shi Nee TanJong-Min KimJisun KimChung Man SungHong Chan KimJongho LeeSang Chul LimDavid P WhiteHyung Chae YangD Andrew Wellman<h4>Purpose</h4>Head rotation is thought to have an effect on obstructive sleep apnea (OSA) severity. However, keeping the head rotated fully during sleep is difficult to maintain, and the effect of head rotation is not the same in all OSA patients. Thus, this study aimed to identify whether less head rotation has an effect on airway patency and determine the responder characteristics to the head rotation maneuver (HRM).<h4>Methods</h4>We recruited 221 patients who underwent overnight polysomnography and drug-induced sleep endoscopy (DISE) in a tertiary hospital from June 2019 to July 2020. Airway patency and the site of airway collapse were determined in the supine position with the head at 0, 30, and 60 degrees of rotation (HRM0°, HRM30°, and HRM60°, respectively) during DISE. The site of collapse was determined using the VOTE classification system: the velum (palate), oropharyngeal lateral walls, tongue base, and epiglottis. Each structure was labeled as 0, 1, or 2 (patent, partially obstructed, and completely obstructed, respectively). Airway response to the HRM30° and 60° and the clinical characteristics associated with airway opening were analyzed.<h4>Results</h4>The study population had a median age of 52 (25-61) years, a body mass index of 26.7(24.6-29.4) kg/m2, and the apnea-hypopnea index (AHI) of 28.2(13.7-71.9) events/h. HRM influenced airway patency positively not only with HRM60° (p<0.001) but also following limited rotation (HRM30°, p<0.001). Patients with tongue base (40.0% with HRM 60°) and epiglottic (52.6% with HRM 60°) collapse responded particularly well to HRM. Multivariate analysis revealed that lower AHI (p<0.001) and an absence of oropharyngeal lateral walls collapse (p = 0.011) were significant predictors of responders to HRM.<h4>Conclusion</h4>Head rotation improved airway obstruction in OSA patients, even with a small degree of rotation, and should be further explored as a potential form of therapy in appropriately selected patients.https://doi.org/10.1371/journal.pone.0268455 |
| spellingShingle | Shi Nee Tan Jong-Min Kim Jisun Kim Chung Man Sung Hong Chan Kim Jongho Lee Sang Chul Lim David P White Hyung Chae Yang D Andrew Wellman Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse. PLoS ONE |
| title | Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse. |
| title_full | Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse. |
| title_fullStr | Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse. |
| title_full_unstemmed | Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse. |
| title_short | Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse. |
| title_sort | head rotation improves airway obstruction especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse |
| url | https://doi.org/10.1371/journal.pone.0268455 |
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