Laryngopharyngeal Reflux and Upper Airway Obstruction Patterns in Nonobese Sleep Apnea Patients

IF 2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Laryngoscope Pub Date : 2025-01-29 DOI:10.1002/lary.32030

Fatih Gul MD, Aslihan Ensari MD, Mehmet Ali Babademez MD

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Abstract

Objectives

The study aims to investigate the relationship between the presence of laryngopharyngeal reflux (LPR) and obstruction levels identified during drug-induced sleep endoscopy (DISE) in obstructive sleep apnea (OSA) among nonobese patients.

Methods

We conducted a prospective study of 105 adult patients diagnosed with OSA who underwent DISE using propofol sedation from 2019 to 2024 at a tertiary hospital. To control for the confounding impact of obesity on LPR, the study selectively enrolled individuals presenting a body mass index within the normal range. LPR was assessed using Reflux Symptom Index and Reflux Finding Score. DISE was performed to evaluate upper airway obstruction at various levels, documented using the VOTE classification system by three blinded reviewers. Hypertrophy of the lingual and palatine tonsils was graded using a four-point scale.

Results

Approximately 48.57% of 105 patients showed the presence of LPR. The chi-square test demonstrated a statistically significant association between LPR and the level of airway obstruction, particularly at the tongue base (p = 0.039). Lingual tonsil hypertrophy Grade 3 at the tongue base and palatine tonsil hypertrophy Grade 3 at the oropharynx both showed significant overrepresentation, with adjusted residual values of 4.0 and 4.8, respectively. Complete tongue base obstruction showed a statistically significant association with LPR, with a strong predictive value in both univariate (β = 2.325, OR = 10.227, p = 0.007) and multivariate analyses (β = 2.295, OR = 9.921, p = 0.008).

Conclusions

The presence of LPR in nonobese OSA patients appears to be significantly associated with an increased likelihood of tongue base obstruction.

Level of Evidence

3 Laryngoscope, 135:2210–2216, 2025

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非肥胖睡眠呼吸暂停患者的喉咽反流和上气道阻塞模式。

目的：本研究旨在探讨非肥胖阻塞性睡眠呼吸暂停（OSA）患者在药物诱导睡眠内镜（DISE）检查中发现的喉咽反流（LPR）与梗阻水平之间的关系。方法：我们对某三级医院2019年至2024年诊断为OSA并使用异丙酚镇静的105例成年OSA患者进行了前瞻性研究。为了控制肥胖对LPR的混杂影响，该研究选择性地招募了体重指数在正常范围内的个体。使用反流症状指数和反流发现评分评估LPR。采用DISE评估不同程度的上气道阻塞，由三名盲法审稿人使用VOTE分类系统进行记录。舌扁桃体和腭扁桃体的肥大采用四分制进行分级。结果：105例患者中约48.57%出现LPR。卡方检验显示LPR与气道阻塞水平有统计学显著相关，尤其是舌基部（p = 0.039）。舌基底扁桃体肥大3级和口咽部腭扁桃体肥大3级均表现出明显的过度代表性，调整后残差值分别为4.0和4.8。完全舌基阻塞与LPR有统计学意义，单因素分析（β = 2.325, OR = 10.227, p = 0.007）和多因素分析（β = 2.295, OR = 9.921, p = 0.008）均具有较强的预测价值。结论：非肥胖OSA患者中LPR的存在似乎与舌底阻塞的可能性增加显著相关。证据等级：3喉镜，2025。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Laryngoscope 医学-耳鼻喉科学

CiteScore

6.50

自引率

7.70%

发文量

500

审稿时长

2-4 weeks

期刊介绍： The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope. • Broncho-esophagology • Communicative disorders • Head and neck surgery • Plastic and reconstructive facial surgery • Oncology • Speech and hearing defects