The Impact of Neck Circumference and <scp>BMI</scp> on Upper Airway Collapsibility and Risk of Complete Concentric Collapse in <scp>OSA</scp>

ABSTRACT Objectives Drug‐induced sleep endoscopy with positive airway pressure (DISE‐PAP) is a novel technique that allows for both qualitative visualization and quantitative measurement of upper airway collapsibility in patients with OSA. We sought to determine whether neck circumference and body mass index (BMI) impact the degree of upper airway collapsibility during DISE‐PAP as measured via pharyngeal opening pressure (PhOP) as well as whether either variable had a measured cutoff point in predicting complete concentric collapse. Methods This was a retrospective, consecutive cohort study of adult sleep‐surgery patients at a tertiary care center from July 2021 to September 2023. Inclusion criteria were adults greater than 18 years of age with OSA (AHI ≥ 5) and a history of CPAP intolerance. All patients underwent DISE‐PAP and were analyzed via VOTE scoring. Results 97 patients were included for neck circumference and 264 patients were included for BMI analysis. On average, the cohort was middle‐aged (51.1 ± 15.1 years), obese (BMI 30.3 ± 4.6 kg/m 2 ), male (70.5%), White (64.8%), with moderate–severe OSA (AHI 33.3 ± 26.2). A mild positive correlation was observed between both neck circumference and BMI and PhOP (Spearman correlation coefficient (SCC) = 0.310, p = 0.002 and SCC 0.237, p = 0.0001, respectively). Both neck circumference and BMI were poor individual predictors of CCC in this population, with no cutoff yielding a clinically meaningful positive predictive value. Conclusion Larger neck circumference and higher BMI are associated with increased collapsibility of the upper airway as quantified by PhOP. Regarding complete concentric collapse, both variables, individually and combined, demonstrate poor predictive value. Level of Evidence 3.