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

Abstract

Study objectives: Epiglottic collapse can obstruct the airway in patients with obstructive sleep apnea in an anteroposterior or lateral direction. 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, eg, oropharyngeal lateral wall collapse or complete concentric collapse of the soft palate, is associated with increased odds for having concurrent lateral epiglottic collapse (E-lat).

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

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 = .006) of having concurrent E-lat. Further, the specific presence of either complete oropharyngeal lateral wall collapse or complete concentric collapse of the soft palate was associated with an odds ratio of 3.4 [1.2-9.6] and 8.6 [2.2-33.5], respectively, of having concurrent E-lat.

Conclusions: Greater prevalence of severe laterally directed pharyngeal collapse, in the form of either complete concentric collapse of the soft palate or oropharyngeal lateral wall 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 E-lat.

Citation: Wang T-Y, Huyett P, Yang H, et al. Lateral epiglottic collapse in obstructive sleep apnea is associated with laterally directed pharyngeal collapse. J Clin Sleep Med. 2025;21(4):649-654.

Keywords: drug-induced sleep endoscopy; epiglottis; obstructive sleep apnea; pharynx; upper airway.