Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May;282(5):2709-2717.
doi: 10.1007/s00405-025-09314-y. Epub 2025 Mar 10.

The role of positional changes in optimizing OSA treatment: evidence from DISE

Michaela Mladoňová  1   2 , Katarína Fedorová  1   2 , Ondřej Jor  3 , Jana Slonková  4 , Adéla Kondé  5   6 , Pavel Komínek  1   2 , Petr Matoušek  7   8
Affiliations

The role of positional changes in optimizing OSA treatment: evidence from DISE

Michaela Mladoňová et al. Eur Arch Otorhinolaryngol. 2025 May.

Abstract

Purpose: This study aimed to assess the impact of positional changes on upper airway obstruction patterns during drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea (OSA) and identify the airway regions most responsive to this change. Special focus was placed on the tongue base, a critical area in OSA pathophysiology.

Methods: This prospective study was conducted from June 2021 to June 2024. DISE was performed in patients with obstructive sleep apnea (OSA) in supine and lateral positions to simulate the effect of positional therapy. Findings were evaluated using the VOTE classification.

Results: The examination was performed on 186 patients, with a median Apnea-Hypopnea Index (AHI) of 19.3. In the supine position, complete obstructions were noted at the soft palate (88.2%), oropharynx (33.3%), tongue base (53.2%), and epiglottis (15.6%). Lateral positioning significantly reduced obstructions, particularly at the tongue base, where obstruction resolved in 94/99 of cases (94.9%). This improvement was significantly more pronounced at the tongue base than at other sites (p < 0.001).

Conclusion: These results suggest that DISE can identify airway regions responsive to positional changes, potentially guiding clinical decisions on positional therapy. The findings show a significant reduction in tongue base obstruction during lateral positioning in DISE. Since tongue base obstruction is a key contributor to airway collapse in OSA, this improvement suggests a practical, non-invasive treatment approach. While these findings highlight an acute association between lateral positioning and reduced obstruction, further studies are needed to evaluate its long-term clinical efficacy.

Keywords: Drug-induced sleep endoscopy; Obstructive sleep apnea; Positional therapy; Tongue base obstruction.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: Mladoňová Michaela, Fedorová Katarína, Jor Ondřej, Slonková Jana, Kondé Adéla, Komínek Pavel and Matoušek Petr declare that they have no conflict of interest. Ethical approval: The study was approved by by the Ethics Committee of the University Hospital Ostrava (identifier: 360/2021) and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

Figures

Fig. 1
Fig. 1
DISE in lateral position; external view
Fig. 2
Fig. 2
Visualization of the structure of patients based on the degree of obstruction before and after positional therapy for each localization (labels for subcategories with a relative frequency below 5% were omitted for better readability)
Fig. 3
Fig. 3
The effect of positional therapy during DISE; 2a—complete tongue base obstruction in supine position; 2b—disappearance of the tongue base obstruction in lateral position; endoscopic view
See this image and copyright information in PMC

Comment in

References

    1. Cahali MB (2019) Revaluing the role of the tongue in obstructive sleep apnea. J Bras Pneumol. 10.1590/1806-3713/e20190208 - PMC - PubMed
    1. Lai YJ, Li CY, Hung CH, Lin CY (2024) Severity of tongue base collapse in various body positions in patients with obstructive sleep apnea: a trajectory analysis. J Formos Med Assoc 123(11):1175–1181. 10.1016/j.jfma.2024.01.033 - PubMed
    1. Hybášková J, Jor O, Novák V, Zeleník K, Matoušek P, Komínek P (2016) Drug-induced sleep endoscopy changes the treatment concept in patients with obstructive sleep apnoea. Biomed Res Int. 10.1155/2016/6583216 - PMC - PubMed
    1. Torre C, Liu SY, Kushida CA, Nekhendzy V, Huon LK, Capasso R (2017) Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug-induced sleep endoscopy. Clin Otolaryngol 42(6):1218–1223. 10.1111/coa.12851 - PubMed
    1. de Vries GE, Hoekema A, Claessen JQPJ, Stellingsma C, Stegenga B, Kerstjens HAM, Wijkstra PJ (2019) Long-term objective adherence to mandibular advancement device therapy versus continuous positive airway pressure in patients with moderate obstructive sleep apnea. J Clin Sleep Med 15(11):1655–1663. 10.5664/jcsm.8034 - PMC - PubMed

LinkOut - more resources