{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:53:36Z","timestamp":1789559616430,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess whether differences exist between ascending pharyngeal opening pressure (PhOP<jats:sub>A<\/jats:sub>) and descending pharyngeal opening pressure (PhOP<jats:sub>D<\/jats:sub>) obtained from positive airway pressure (PAP) titrations during drug\u2010induced sleep endoscopy (DISE) and to identify the associations between the physiologic and anatomic constituents of these differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Cross\u2010sectional study of a prospective, single\u2010site sleep surgery cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Quaternary care center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive patients with obstructive sleep apnea undergoing DISE with PAP were enrolled. PAP was raised in a stepwise manner until inspiratory airflow limitation was abolished (PhOP<jats:sub>A<\/jats:sub>), then decreased until just before airflow limitation reappeared (PhOP<jats:sub>D<\/jats:sub>). Negative effort dependence (NED) was calculated in flow\u2010limited breaths as the percentage difference in nasal airflow from peak to plateau. Anatomic measures included both computed tomography (CT) and VOTE scores. PhOP<jats:sub>A<\/jats:sub> and PhOP<jats:sub>D<\/jats:sub> were compared using paired <jats:italic>t<\/jats:italic> tests. Associations with the percent difference in PhOP values (PhOP<jats:sub>A\u2010D<\/jats:sub>) were evaluated using Pearson's correlations or analysis of variance for continuous or categorical measures, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In a cohort of 43 patients, PhOP<jats:sub>A<\/jats:sub> was greater than PhOP<jats:sub>D<\/jats:sub> (7.41\u2009\u00b1\u20092.55 vs 6.02\u2009\u00b1\u20091.77\u2009cm\u2009H<jats:sub>2<\/jats:sub>O, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.01). For patients with nonequivalent PhOP<jats:sub>A\u2010D<\/jats:sub>, the mean PhOP<jats:sub>A\u2010D<\/jats:sub> was 1.88\u2009\u00b1\u20091.33\u2009cm\u2009H<jats:sub>2<\/jats:sub>O, or a percent difference of 21.95%\u2009\u00b1 10.37%. In both unadjusted and adjusted analyses, higher PhOP<jats:sub>A\u2010D<\/jats:sub> was associated with higher NED (<jats:italic>r<\/jats:italic>\u2009=\u20090.46, <jats:italic>P<\/jats:italic>\u2009=\u2009.003) and with more negative pharyngeal pressure (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.48, <jats:italic>P<\/jats:italic>\u2009=\u2009.002). Patients with a nonequivalent PhOP<jats:sub>A\u2010D<\/jats:sub> were more likely to have complete lateral wall obstruction on VOTE (<jats:italic>P<\/jats:italic>\u2009=\u2009.03). The present study showed no statistically significant associations with CT findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The correlation of PhOP<jats:sub>A\u2010D<\/jats:sub> with negative pharyngeal pressure supports the ability of DISE to partition passive versus active contributions to upper airway obstruction. Higher PhOP<jats:sub>A\u2010D<\/jats:sub> highlights the possible extrapharyngeal drivers of upper airway obstruction, particularly ventilatory drive and respiratory effort. DISE\u2010PAP with ascending and descending titrations can potentially be used in conjunction with anatomic findings on CT and VOTE scoring to offer insights into patient selection for sleep surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level 2.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1354","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T11:19:13Z","timestamp":1753183153000},"page":"1014-1023","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ascending and Descending Pharyngeal Opening Pressures During Drug\u2010Induced Sleep Endoscopy: Mechanistic Insights for Sleep Surgeons"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9971-4852","authenticated-orcid":false,"given":"Linda C.","family":"Maga\u00f1a","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"},{"name":"Division of Sleep Medicine University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tice","family":"Harkins","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yash","family":"Dixit","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Wiemken","sequence":"additional","affiliation":[{"name":"Division of Sleep Medicine University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan T.","family":"Keenan","sequence":"additional","affiliation":[{"name":"Division of Sleep Medicine University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Everett G.","family":"Seay","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Thuler","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan 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