{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:14:04Z","timestamp":1787069644009,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,7,21]],"date-time":"2024-07-21T00:00:00Z","timestamp":1721520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,7,21]],"date-time":"2024-07-21T00:00:00Z","timestamp":1721520000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Obstructive sleep apnea (OSA) is a prevalent disorder, with oral breathing influencing its severity. Expiratory velopharyngeal obstruction (EVO), observed during drug\u2010induced sleep endoscopy (DISE), may contribute to oral breathing in OSA patients. EVO results in obstruction between the pharynx and nasal cavity during expiration. This study aims to identify factors associated with positive EVO during DISE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Case series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary Medical Center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Seventy\u2010two OSA patients underwent clinical evaluation, polysomnography, and DISE, utilizing interventions like intraoral negative airway pressure (iNAP), mouth closure, and oral appliances (OAs) in supine positions with head rotation. The findings, classified under velopharynx, oropharynx, tongue base, epiglottis, included the presence of EVO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The results demonstrated that interventions including mouth closure and iNAP were associated with increased observation of EVO (43.1% and 34.7%) compared to OA (20.1%). However, head rotation was associated with decreased presence of EVO during DISE compare to supine (26% vs\u00a035.8%). Noticeably, per 1 year increase of age was associated with an increased odds of EVO (odds ratio: 1.03, 95% confidence interval: 1.01\u20101.06). However, no other baseline characteristics were significantly associated the odds of EVO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study reveals the effectiveness of head rotation and OA in reducing EVO and improving mouth breathing in OSA patients, offering valuable insights for future treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.902","type":"journal-article","created":{"date-parts":[[2024,7,21]],"date-time":"2024-07-21T03:59:45Z","timestamp":1721534385000},"page":"1591-1600","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Expiratory Velopharyngeal Obstruction: Sleep Endoscopy\u2010Guided Treatment Strategies to Prevent Oral Breathing During Sleep"],"prefix":"10.1002","volume":"171","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5028-2489","authenticated-orcid":false,"given":"Ying\u2010Shuo","family":"Hsu","sequence":"first","affiliation":[{"name":"Institute of Brain Science National Yang Ming Chiao Tung University Taipei Taiwan (ROC)"},{"name":"Sleep Research Center National Yang Ming Chiao Tung University Taipei Taiwan (ROC)"},{"name":"Department of Otolaryngology Shin Kong Wu\u2010Ho\u2010Su Memorial Hospital Taipei Taiwan (ROC)"},{"name":"School of Medicine Fu Jen Catholic University New Taipei City Taiwan (ROC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan\u2010Kai","family":"Ke","sequence":"additional","affiliation":[{"name":"Department of Oral &amp; Maxillofacial Surgery Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation New Taipei City Taiwan (ROC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry B. J.","family":"Kuo","sequence":"additional","affiliation":[{"name":"Institute of Brain Science National Yang Ming Chiao Tung University Taipei Taiwan (ROC)"},{"name":"Sleep Research Center National Yang Ming Chiao Tung University Taipei Taiwan (ROC)"},{"name":"Brain Research Center National Yang Ming Chiao Tung University Taipei Taiwan (ROC)"},{"name":"Department of Education and Research Taipei City Hospital Taipei Taiwan (ROC)"},{"name":"Clinical Research Center, Taoyuan Psychiatric Center Ministry of Health and Welfare Taoyuan Taiwan (ROC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Shin Kong Wu Ho\u2010Su Memorial Hospital Taipei Taiwan (ROC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2290-0520","authenticated-orcid":false,"given":"Ofer","family":"Jacobowitz","sequence":"additional","affiliation":[{"name":"Sleep department ENT and Allergy Associates New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Mo","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Chest Medicine Shin Kong Wu Ho\u2010Su Memorial Hospital Taipei City Taiwan (ROC)"},{"name":"Department of Chemistry Fu Jen Catholic University New Taipei City Taiwan (ROC)"},{"name":"Graduate Institute of Biomedical and Pharmaceutical Science Fu Jen Catholic University New Taipei City Taiwan (ROC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Chieh","family":"Lo","sequence":"additional","affiliation":[{"name":"Institute of Brain Science National Yang Ming Chiao Tung University Taipei Taiwan (ROC)"},{"name":"Leading Dental Group Taipei Taiwan (ROC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl C. 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