ArticleJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2026
Positive airway pressure-associated epiglottis-related obstruction in adult men with obstructive sleep apnea.
Maxwell L Weng, Daniel Vena, Andrew Wellman, Atul Malhotra, Scott A Sands, Phillip Huyett, Eric J Kezirian
Erratum issuedAbstract read
In one paragraphArticle in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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What it found
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2 · The registryThe trial behind it
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4 · The recordCorrections and comments
5 · Who and what moneyAuthors and funding
7 authors.
Maxwell L WengDepartment of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Daniel VenaDivision of Sleep and Circadian Disorders, Brigham and Women's Hospitaland , Harvard Medical School, Boston, MA, USA.
Andrew WellmanDivision of Sleep and Circadian Disorders, Brigham and Women's Hospitaland , Harvard Medical School, Boston, MA, USA.
Atul MalhotraDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California San Diego, San Diego, CA, USA.
Scott A SandsDivision of Sleep and Circadian Disorders, Brigham and Women's Hospitaland , Harvard Medical School, Boston, MA, USA.
Phillip HuyettDepartment of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA.
Eric J KezirianDepartment of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. EKezirian@mednet.ucla.edu.ORCID http://orcid.org/0000-0003-3808-4521 Funding
UCLA Clinical Translational Science InstituteUL1TR001881 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ARLEEN F. BROWN, ARASH NAEIM · 2016 to 2026
$118.1MValidation of a Phenotype Model to Predict Response to Alternative OSA TreatmentsR01HL102321 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI WELLMAN, DAVID ANDREW · 2011 to 2025
$7.3MDetermination of the site of pharyngeal collapse in Obstructive Sleep Apnea patients from snoring soundsR01HL128658 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI WELLMAN, DAVID ANDREW · 2016 to 2025
$4.3MIs Obstructive Sleep Apnea Important in the Development of Alzheimer's DiseaseR01AG063925 · NIA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MALHOTRA, ATUL · 2020 to 2024
$3.7MUnderlying mechanisms of obesity-induced obstructive sleep apneaR01HL148436 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Atul Malhotra · 2020 to 2026
$3.4MA Novel Pharmacological Therapy for Obstructive Sleep ApneaR01HL146697 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI SANDS, SCOTT A · 2019 to 2023
$3.4MSleep Apnea Endophenotypes: One Size Does Not Fit AllR01HL154926 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MALHOTRA, ATUL · 2021 to 2025
$3.3MThe cardiovascular consequences of sleep apnea plus COPD (Overlap syndrome)R01HL166485 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Atul Malhotra · 2023 to 2026
$3.1MVentNet: A Real-Time Multimodal Data Integration Model for Prediction of Respiratory Failure in Patients with COVID-19R01HL157985 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI MALHOTRA, ATUL, NEMATI, SHAMIM · 2022 to 2025
$2.9MUpper airway collapsibility, loop gain and arousal threshold: an integrative therapeutic approach to obstructive sleep apneaR01HL160993 · NHLBI · UNIVERSITY OF SOUTHERN CALIFORNIA · PI KEZIRIAN, ERIC JAMES · 2022 to 2025
$2.6MDeveloping a Diverse Next Generation of Leaders in Respiratory ScienceT32HL166127 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Laura Elise Crotty Alexander, Atul Malhotra · 2023 to 2026
$1.6MAmerican Academy of Sleep Medicine 257-FP-21American Heart Association 938014NCATS NIH HHS UL1 TR001881NHLBI NIH HHS HL102321NHLBI NIH HHS HL128658NHLBI NIH HHS HL160993NHLBI NIH HHS R01 HL102321NHLBI NIH HHS R01 HL128658NHLBI NIH HHS R01 HL146697NHLBI NIH HHS R01 HL148436NHLBI NIH HHS R01 HL154926NHLBI NIH HHS R01 HL157985NHLBI NIH HHS R01 HL160993NHLBI NIH HHS R01 HL166485NHLBI NIH HHS T32 HL166127NIA NIH HHS R01 AG063925
6 · The paper itselfAbstract
purposeTo characterize changes in ventilation and inspiratory airflow associated with visual evidence of epiglottis-related obstruction during drug-induced sleep endoscopy (DISE) with positive airway pressure (PAP) administration among adults with obstructive sleep apnea (OSA).
methodsThis was a case-control study of adults with OSA undergoing DISE with measurement of airflow and mask pressure, prior to and during PAP administration. Cases were defined by visual evidence of partial or complete epiglottis-related obstruction, whether prior to and/or with PAP. Each case was matched to a control with an identical visual obstruction pattern (other than for the epiglottis) prior to PAP (if available), with attempted matching on age and BMI. For each breath, ventilation and mean inspiratory airflow were calculated, along with the endoscopic degree of visual epiglottis-related obstruction.
resultsFrom 150 study participants, 26 cases with 2050 breaths and 14 matched controls with 1353 breaths were selected. With increasing PAP level and mask pressure, 19 cases (13% of total study participants) had some decrease in ventilation or mean inspiratory airflow. Increasing mask pressure was associated with increased ventilation and mean inspiratory airflow in controls at all pressures and in cases before the onset of visual epiglottis-related obstruction. Among cases, once visual epiglottis-related obstruction emerged, increasing mask pressure was associated with decreasing ventilation and mean inspiratory airflow relative to the pattern in controls and cases at lesser mask pressures.
conclusionVisual epiglottis-related obstruction during DISE with PAP occurs in some individuals that limits increases in ventilation and mean inspiratory airflow normally seen with increases in PAP levels.
Indexed as
Airway ObstructionContinuous Positive Airway PressureEpiglottisSleep Apnea, ObstructiveAdultCase-Control StudiesEndoscopyHumansMaleMiddle AgedPolysomnographyDrug-induced sleep endoscopyEpiglottisObstructive sleep apneaPositive airway pressure
Identifiers
PMID42260258
PMCPMC13247008
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