Sleep apnea patients with epiglottic collapse elevate their larynx more with swallowing; videofluoroscopic swallowing study of 80 patients

Hyung Chae Yang; Alphonse Umugire; Min-Keun Song; Sung Chung Man; Hong Chan Kim; Jisun Kim; Daniel Vena; Phillip Huyett; Insung Choi; Andrew D Wellman

doi:10.1007/s11325-024-03065-6

Sleep apnea patients with epiglottic collapse elevate their larynx more with swallowing; videofluoroscopic swallowing study of 80 patients

Sleep Breath. 2024 May 25. doi: 10.1007/s11325-024-03065-6. Online ahead of print.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
² Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, 42 Jebong-ro Dong-gu, Gwangju, 61479, South Korea. drsongmk@jnu.ac.kr.
³ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
⁵ Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, 42 Jebong-ro Dong-gu, Gwangju, 61479, South Korea. drchoiis@daum.net.

^# Contributed equally.

PMID: 38795279
DOI: 10.1007/s11325-024-03065-6

Abstract

Objective: The epiglottis plays an integral role in the swallowing mechanism and is also implicated as an obstruction site in obstructive sleep apnea (OSA). The underlying causes of epiglottic collapse during sleep remain unclear. This study aimed to investigate the cognitive functions using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the neurophysiological and anatomical factors using videofluoroscopic swallowing studies (VFSS). We compared patients with OSA exhibiting epiglottic collapse to those without, assessing differences in anatomical or neurophysiological characteristics.

Methods: The study included 12 patients with epiglottic collapse (Epi-group) and 68 without (non-Epi group), all undergoing overnight polysomnography (PSG), drug-induced sleep endoscopy (DISE), LOTCA, and VFSS. Oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were considered as neurophysiological traits, and laryngeal elevation length (LE) as anatomical trait, and were measured across various test diets (10 ml of liquid, soft, or solid).

Results: The study comprised 80 individuals, 57 men and 23 women, with no significant age, sex, body mass index or PSG parameters between groups, or DISE findings, with the exception of epiglottic collapse. Swallowing metrics from VFSS were normal, with no differences in OTT, PDT, PTT, or LOTCA scores. Notably, patients with epiglottic collapse showed a greater laryngeal elevation when swallowing soft and solid foods (p = 0.025 and p = 0.048, respectively).

Conclusions: Patients with epiglottic collapse do not exhibit neurophysiological or cognitive impairments when compared to non-Epi group. However, the Epi-group displayed a significantly increased laryngeal elevation length. This suggests that anatomical factors may have a more substantial role in the development of epiglottic collapse than neurophysiological factors.

Keywords: Anatomical factors; Epiglottis collapse; Obstructive sleep apnea; Oropharyngolaryngeal structure; Videofluoroscopic swallowing study.

Abstract

Grants and funding