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CC BY 4.0 · Int Arch Otorhinolaryngol 2024; 28(02): e255-e262
DOI: 10.1055/s-0043-1776719
Original Research

Types of Epiglottic Collapse in Breathing Sleep Disorder and Their Impact in Clinical Practice

Elvie Zulka Kautzia Rachmawati 
1   Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Susyana Tamin 
1   Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Fauziah Fardizza 
1   Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Rahmanofa Yunizaf 
1   Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Fikri Mirza Putranto 
2   Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Universitas Indonesia Hospital, Depok, Indonesia
,
Niken Ageng Rizki 
1   Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
,
Retno S. Wardani 
1   Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
› Author Affiliations Funding Sources This work received no specific grant from any funding agency in the not-for-profit, commercial, or public sectors.
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Abstract

Introduction Obstructive sleep apnea (OSA) is a severe form of sleep-disordered breathing (SDB) that is strongly correlated with comorbidities, in which epiglottic collapse (EC) and other contributing factors are involved.

Objectives To evaluate the occurrence of EC in OSA patients through drug-induced sleep endoscopy (DISE) and to determine the factors contributing to EC.

Methods A retrospective study of 37 adult patients using medical history. Patients were assessed for laryngopharyngeal reflux (LPR) and lingual tonsil hypertrophy (LTH) using reflux symptom index and reflux finding score (RFS); for OSA using polysomnography, and for airway collapse through DISE. An independent t-test was performed to evaluate risk factors, including the involvement of three other airway structures.

Results Most EC patients exhibited trap door epiglottic collapse (TDEC) (56.8%) or pushed epiglottic collapse (PEC) (29.7%). Lingual tonsil hypertrophy, RFS, and respiratory effort-related arousal (RERA) were associated with epiglottic subtypes. Laryngopharyngeal reflux patients confirmed by RFS (t(25) = −1.32, p = 0.197) tended to suffer PEC; LTH was significantly associated (X2(1) = 2.5, p = 0.012) with PEC (odds ratio [OR] value = 44) in grades II and III LTH patients; 11 of 16 TDEC patients had grade I LTH. Pushed epiglottic collapse was more prevalent among multilevel airway obstruction patients. A single additional collapse site was found only in TDEC patients.

Conclusion Laryngopharyngeal reflux causes repetitive acid stress toward lingual tonsils causing LTH, resulting in PEC with grade II or III LTH. Trap door epiglottic collapse requires one additional structural collapse, while at least two additional collapse sites were necessary to develop PEC. Respiratory effort-related arousal values may indicate EC.

Keywords

drug-induced sleep endoscopy - epiglottic collapse - laryngopharyngeal reflux - lingual tonsil hypertrophy - obstructive sleep apnea - VOTE classification

Statement of Ethics

This study protocol was reviewed and approved by the Faculty of Medicine Universitas Indonesia ethical committee, under approval number [0840/UN2/F1/ETIK/2018], in August 2018. Written informed consent was obtained from each participant in the study.


Data Availability Statement

The datasets used and/or analyzed during this study are available in this article and its supplementary material files. Further inquiries should be directed to the corresponding author.




Publication History

Received: 09 May 2022

Accepted: 29 June 2023

Article published online:
24 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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