{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:09:02Z","timestamp":1793383742045,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,3,21]],"date-time":"2017-03-21T00:00:00Z","timestamp":1490054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The primary objective of the study was to understand the differential impact of continuous positive airway pressure (<jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content>) on the location, degree and pattern of airway collapse in obstructive sleep apnea (<jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content>) patients utilizing drug\u2010induced sleep endoscopy (<jats:styled-content style=\"fixed-case\">DISE<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Non\u2010randomized trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>University Medical Center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Fifteen consecutive <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> patients undergoing <jats:styled-content style=\"fixed-case\">DISE<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcomes and measures<\/jats:title><jats:p>The patterns of airway collapse were videorecorded at baseline and under differential application of nasal <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">nCPAP<\/jats:styled-content>) at 5, 10 and 15 cm H<jats:sub>2<\/jats:sub>O. For each modality, the pattern and degree of airway collapse were analyzed by three independent observers using the velum, oropharynx, tongue base, epiglottis (<jats:styled-content style=\"fixed-case\">VOTE<\/jats:styled-content>) classification system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The modest <jats:styled-content style=\"fixed-case\">nCPAP<\/jats:styled-content> pressures (10 cm H<jats:sub>2<\/jats:sub>O) had the greatest impact on the lateral walls of the pharynx, followed by the palatal region. The collapsibility of the tongue base and epiglottis demonstrated significant resistance to <jats:styled-content style=\"fixed-case\">nCPAP<\/jats:styled-content> application, which was overcome by increasing <jats:styled-content style=\"fixed-case\">nCPAP<\/jats:styled-content> to 15 cm H<jats:sub>2<\/jats:sub>O. Compared to 5 cm H<jats:sub>2<\/jats:sub>O, <jats:styled-content style=\"fixed-case\">nCPAP<\/jats:styled-content> pressures of 10 and 15 cm H<jats:sub>2<\/jats:sub>O improved complete collapse at least at one level of the upper airway (<jats:italic>P<\/jats:italic>=.016 and .001, respectively). Increased <jats:styled-content style=\"fixed-case\">nCPAP<\/jats:styled-content> pressures also led to changes in the configuration of airway collapse at the level of the velum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The differential <jats:styled-content style=\"fixed-case\">nCPAP<\/jats:styled-content> effects observed in this study may help to understand some of the mechanisms responsible for inadequate patient response and poor <jats:styled-content style=\"fixed-case\">nCPAP<\/jats:styled-content> compliance. The use of <jats:styled-content style=\"fixed-case\">DISE<\/jats:styled-content> in combination with <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content> may serve as a first step in optimizing patients that failed to adapt to treatment with <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content>. This approach can help the physician identify patterns of airway collapse that may require varying pressures different from the one the patient is using, as well as anatomical factors that may be corrected to help with compliance.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12851","type":"journal-article","created":{"date-parts":[[2017,2,16]],"date-time":"2017-02-16T18:02:46Z","timestamp":1487268166000},"page":"1218-1223","source":"Crossref","is-referenced-by-count":43,"title":["Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug\u2010induced sleep endoscopy"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0273-9901","authenticated-orcid":false,"given":"C.","family":"Torre","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Miller School of Medicine University of Miami Miami FL USA"},{"name":"Division of Sleep Surgery Department of Otolaryngology\u2010Head 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