JAMA Network JAMA Otolaryngology–Head & Neck Surgery : Anteroposterior and Lateral Epiglottis-Related Obstruction in Adult Obstructive Sleep Apnea
Oct 9, 2025
In this engaging discussion, Dr. Eric J. Kezirian, a leading expert in obstructive sleep apnea from UCLA, shares insights from his 20 years of experience. He explains drug-induced sleep endoscopy and its role in identifying airway obstructions. Listeners learn about the VOTE classification system, how anterior-posterior and lateral epiglottis configurations affect treatment outcomes, and the predictive value of awake exams. Kezirian also discusses the future of personalized interventions based on epiglottis anatomy and the importance of DISE in surgical planning.
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DISE Reveals Surgical Targets
- Drug-induced sleep endoscopy (DISE) simulates natural sleep to locate pharyngeal structures causing obstruction.
- Eric J. Kezirian uses DISE to target interventions like surgery or oral appliances based on anatomic findings.
VOTE Classification Frames Obstruction
- The VOTE classification categorizes collapse by velum, oropharyngeal lateral walls, tongue, and epiglottis.
- Kezirian used VOTE to study epiglottis-related obstruction patterns across a large cohort.
Two Distinct Epiglottis Patterns
- Epiglottis-related obstruction occurs in about 15% of patients undergoing DISE.
- Kezirian differentiated two configurations: anteroposterior displacement and a less common lateral folding.