Pharyngeal Opening Pressure More Common in Black Patients with OSA

Pharyngeal opening pressure (PhOP) was not associated with significant correlation to neither body mass index (BMI), apnea-hypopnea index (AHI), nor age in patients with obstructive sleep apnea (OSA) and intolerance to continuous positive airway pressure (CPAP) therapy, according to findings.

Data presented at the SLEEP 2024 Annual Meeting in Houston, TX, this week, helped to distinguish the relationship of patient demographic and clinical features relative to upper airway collapsibility in patients with OSA. The findings additionally noted a significant prevalence of PhOP among patients who identified as African American.

“Drug-induced sleep endoscopy with positive airway pressure (DISE-PAP) can provide both quantitative and qualitative metrics of upper airway collapsibility in patients with obstructive sleep apnea with the use of PhOP,” investigators, led by Thomas Chapman of Rush University Medical Center, wrote. “In this study, we sought to build upon prior research evaluating the relationship of clinical and demographic features of upper airway collapsibility in a larger, more diverse patient population.”

The team conducted a retrospective, consecutive cohort analysis of adult sleep surgery patients referred to non-CPAP alternative care for their OSA. Each eligible patient was ≥18 years old with a history of OSA per AHI >5 at baseline and CPAP intolerance. They all had been evaluated by an experienced sleep surgeon at a tertiary care facility between July 2021 – October 2023.

Chapman and colleagues sought a primary outcome of PhOP via stepwise titration of positive airway pressure via a nasal PAP until airway obstruction was alleviated by DISE. The team additionally collected patient demographic data, clinical findings, symptom questionnaire outcomes and relevant sleep studies via electronic medical record. They evaluated the relationship between PhOP and patient characteristics via regression models.

The final analysis included 289 patients; mean age was 51.6 years old, and mean BMI was 30.2. A majority of patients were male (71.1%) and identified as White (64.6%). Patients primarily reported moderate-severe OSA, with a mean AHI of 33.9. Mean PhOP was 7.9.

Investigators observed a mean PhOP increase of 0.15 cm per 1-point increase in patient BMI. They additionally observed that PhOP was correlated with AHI 3%—however, the association was not statistically significant (Spearman coefficient, 0.283; P <.001).

The team additionally noted that age did not significantly associate with PhOP score (P = .0116). In an exploratory analysis where BMI was controlled as a factor, Chapman and colleagues observed PhOP was 2.3-fold greater in patients who identified as Black or African American versus patients who identified as White patients. No other such race/ethnicity-related association was observed with PhOP.

“Pharyngeal opening pressure demonstrated a weak correlation with both BMI and AHI and no clinically significant relationship with age,” investigators concluded. “PhOP was significantly higher in patients identifying as African American which has not been demonstrated previously and requires further investigation.”

References

^{Chapman T, Harsh P, Whitehead R, Zhang Y, et al. Demographic and Clinical Features of Upper Airway Collapsibility. Paper presented at: Associated Professional Sleep Societies (SLEEP) 2024 Annual Meeting. Houston, TX. June 1 – 5, 2024.}