{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T01:09:30Z","timestamp":1781140170337,"version":"3.54.1"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,5,20]],"date-time":"2023-05-20T00:00:00Z","timestamp":1684540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify the value of head rotation in the supine position and oral appliance (OA) use in drug\u2010induced sleep endoscopy (DISE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Eighty\u2010three sleep apnea adults undergoing target\u2010controlled infusion\u2010DISE (TCI\u2010DISE) were recruited from a tertiary academic medical center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>During DISE, 4 positions were utilized: supine position (position 1), head rotation (position 2), mandibular advancement using an OA (position 3), and head rotation with an OA (position 4).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Polysomnography (PSG) data and anthropometric variables during DISE were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty\u2010three patients (65 men and 18 women; mean [standard deviation, SD], 48.5 [11.0] years) who underwent PSG and TCI\u2010DISE were included. The mean (SD) apnea\u2013hypopnea index (AHI) was 35.5 (22.4)\u2009events\/h. Twenty\u2010three patients had persistent complete concentric velopharyngeal collapse in the supine position, even with concurrent head rotation and OA (position 4). Their mean (SD) AHI was 54.7 (24.6)\u2009events\/h, significantly higher than that of the 60 patients without such collapse in position 4 (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Their mean (SD) body mass index (BMI) was 29.0 (4.1)\u2009kg\/m<jats:sup>2<\/jats:sup>, also significantly higher (<jats:italic>p<\/jats:italic>\u2009=\u2009.005). After adjustment for age, BMI, tonsil size, and tongue position, the degree of velum and tongue base obstruction was significantly associated with sleep apnea severity in positions 2, 3, and 4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We showed the feasibility, safety, and usefulness of using simple edge\u2010to\u2010edge, reusable OA in DISE. Patients who are not responsive to head rotation and OA during TCI\u2010DISE may need upper airway surgery and\/or weight control.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.364","type":"journal-article","created":{"date-parts":[[2023,5,21]],"date-time":"2023-05-21T02:20:02Z","timestamp":1684635602000},"page":"1345-1355","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Upper Airway Surgery or Weight Control? 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