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Patients with Epiglottic Collapse are Less Adherent to Autotitrating Positive Airway Pressure Therapy for Obstructive Sleep Apnea.

Rationale The anatomic orientation of the epiglottis is such that it points in the opposite direction to inspiratory flow, thereby potentially making positive airway pressure (PAP) treatment challenging in patients with epiglottic collapse. However, no previous studies have analyzed PAP adherence in these patients. Objective(s) This study aimed to analyze adherence to autotitrating positive airway pressure (APAP) treatment in patients with epiglottic collapse. Methods We performed an age and sex-matched case-control study. Based on their overnight level-I polysomnogram, patients were prescribed APAP in a tertiary hospital between July 2018 and March 2019. The site of airway collapse was diagnosed with drug induced sleep endoscopy. Demographic factors, sleep questionnaire, polysomnography, and APAP usage statistics were analyzed. Results Eighteen patients with epiglottic collapse (Epi-group) and 36 without epiglottic collapse (Controls) were analyzed. We found that 22.8% of patients in the Epi-group terminated APAP within 2 weeks, whereas only 2.8% of patients in the Control group terminated APAP within 2 weeks (p=0.048). The percentage of days with usage over 4 hours was significantly lower in the Epi-group (64.6% vs. 75.6%, p=0.008). In addition, the adherence failure rate was 66.7% in the Epi-group and 33.3% in the Control group (p=0.039). Patients with epiglottic collapse were also found to have lower BMI, which is an unfavorable predictor of APAP adherence. Conclusion This study suggests that patients with epiglottic collapse have a higher APAP adherence failure rate than patients without epiglottic collapse. Thus, patients with epiglottic collapse should be followed closely during treatment, and alternative therapies should probably be considered for these patients.