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Notably, complete concentric collapse at the level of the palate (CCCp) during drug-induced sleep endoscopy (DISE) is associated with reduced efficacy of hypoglossal nerve stimulation, but CCCp is currently not recognisable using polysomnography. Here we develop a means to estimate DISE-based site of collapse using overnight polysomnography.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>182 OSA patients provided DISE and polysomnography data. Six polysomnographic flow shape characteristics (mean during hypopnoeas) were identified as candidate predictors of CCCp (primary outcome variable, n=44\/182), including inspiratory skewness and inspiratory scoopiness. Multivariable logistic regression combined the six characteristics to predict clear presence (n=22)<jats:italic>versus<\/jats:italic>absence (n=128) of CCCp (partial collapse and concurrent tongue base collapse excluded). Odds ratios for actual CCCp between predicted subgroups were quantified after cross-validation. Secondary analyses examined complete lateral wall, tongue base or epiglottis collapse. External validation was performed on a separate dataset (n<jats:sub>total<\/jats:sub>=466).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CCCp was characterised by greater scoopiness (\u03b2=1.5\u00b10.6 per 2<jats:sc>sd<\/jats:sc>, multivariable estimate\u00b1<jats:sc>se<\/jats:sc>) and skewness (\u03b2=11.4\u00b12.4) compared with non-CCCp. The odds ratio for CCCp in predicted positive<jats:italic>versus<\/jats:italic>negative subgroups was 5.0 (95% CI 1.9\u201313.1). The same characteristics provided significant cross-validated prediction of lateral wall (OR 6.3, 95% CI 2.4\u201316.5), tongue base (OR 3.2, 95% CI 1.4\u20137.3) and epiglottis (OR 4.4, 95% CI 1.5\u201312.4) collapse. CCCp and lateral wall collapse shared similar characteristics (skewed, scoopy), diametrically opposed to tongue base and epiglottis collapse characteristics. External validation confirmed model prediction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current study provides a means to recognise patients with likely CCCp or other DISE-based site of collapse categories using routine polysomnography. Since site of collapse influences therapeutic responses, polysomnographic airflow shape analysis could facilitate precision site-specific OSA interventions.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.00261-2024","type":"journal-article","created":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T16:45:23Z","timestamp":1711644323000},"page":"2400261","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":20,"title":["Polysomnographic airflow shapes and site of collapse during drug-induced sleep endoscopy"],"prefix":"10.1183","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5978-9814","authenticated-orcid":false,"given":"Sara","family":"Op de 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