Patterns of Obstruction on DISE in Adults With Obstructive Sleep Apnea Change With BMI

Stephanie J. Wong, Martha E. Luitje, Sveta Karelsky

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objectives: We describe drug-induced sleep endoscopy (DISE) obstruction patterns in adults with obstructive sleep apnea (OSA) based on body mass index (BMI). We also evaluate subgroups of patients with clinically significant obstruction patterns at the velopharynx and oropharynx. Study Design: Retrospective chart review. Methods: Single-institution, retrospective chart review of adults with OSA who underwent DISE with dexmedetomidine sedation from 2016 to 2018. Endoscopic findings were graded using VOTE (Velum, Oropharynx, Tongue base, Epiglottis) classification. Oropharyngeal obstruction was additionally graded with the modifier T when due to palatine tonsil tissue. Findings in patients who had BMI < 25, 25 ≤ BMI < 30, and BMI ≥ 30 were compared. Results: One hundred and eleven patients (1 underweight, 23 normal weight, 56 overweight, and 31 obese) were reviewed. Patients with lower BMI were more likely to have more severe obstruction at the level of the tongue base (χ2 = 11.52, P =.021) and epiglottis (χ 2 = 10.56, P =.032). Conversely, patients with higher BMI were more likely to have complete concentric (grade 2C) velum obstruction (χ 2 = 16.04, P <.001) and more severe oropharyngeal obstruction (χ 2= 9.65, P =.046). Patients with grade 2 oropharyngeal obstruction without tonsil obstruction had more severe concurrent velum obstruction compared to subjects with grade 2 T oropharyngeal obstruction (P =.009). Conclusion: In adults with OSA, BMI categories have significantly distinct obstruction patterns at all airway levels on DISE, and there appear to be distinct subgroups associated with certain velum and oropharynx collapse patterns. These findings may have important implications for positive airway pressure–alternative treatment. Level of Evidence: 3 Laryngoscope, 131:224–229, 2021.

Original languageEnglish
Pages (from-to)224-229
Number of pages6
Issue number1
StatePublished - Jan 2021
Externally publishedYes


  • Drug-induced sleep endoscopy, obstructive sleep apnea, BMI, obesity


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