J Int Med Res. 2026 Sep;54(9):3000605261480899. doi: 10.1177/03000605261480899. Epub 2026 Sep 28.
ABSTRACT
ObjectiveTo evaluate whether upper-airway collapse phenotypes recorded during drug-induced sleep endoscopy were associated with the presence of cardiometabolic comorbidity in adults with polysomnography-confirmed obstructive sleep apnea.MethodsThis single-center retrospective cross-sectional study analyzed 360 drug-induced sleep endoscopy evaluation records from 355 adults. The primary outcome was at least one documented diagnosis of hypertension, diabetes mellitus, coronary artery disease, or cerebrovascular disease. Baseline supine velum-oropharynx-tongue base-epiglottis severity was coded as grade 0, 1, or 2; site-level collapse was defined as grade ≥1. Logistic regression was adjusted for age, sex, body mass index, apnea-hypopnea index, all velum-oropharynx-tongue base-epiglottis sites, and complete concentric velum collapse. Sensitivity analyses examined severity, pattern, repeated identifiers, multiplicity, model fit, and incremental value.ResultsCardiometabolic comorbidity was present in 156/360 records (43.3%). Epiglottic collapse was less frequent with than without comorbidity (17.3% vs. 29.4%). In the primary model, epiglottic collapse showed a nominal inverse association (adjusted odds ratio = 0.55; 95% confidence interval: 0.32-0.95; p = 0.031), but the Holm-adjusted p value across adjusted drug-induced sleep endoscopy predictors was 0.153. In exploratory sensitivity analyses, complete, but not partial, epiglottic collapse showed lower estimated odds (complete vs. none: adjusted odds ratio = 0.42; 95% confidence interval: 0.22-0.80; p = 0.008). The clinical model area under the receiver operating characteristic curve was 0.675 vs. 0.694 after adding drug-induced sleep endoscopy variables; the likelihood-ratio test was not significant (p = 0.203).ConclusionsEpiglottic collapse showed an exploratory inverse cross-sectional association with documented cardiometabolic comorbidity. The association did not remain significant after multiplicity correction and should not be interpreted as protective, temporal, or predictive. Protocolized prospective validation is required.
PMID:42805916 | DOI:10.1177/03000605261480899