Race‐Based Differences in Velopharyngeal Collapse Patterns During Drug‐Induced Sleep Endoscopy

OBJECTIVE: To investigate race-based differences in upper-airway collapse patterns during drug-induced sleep endoscopy (DISE) and assess their potential contribution to disparities in hypoglossal nerve stimulation (HGNS) eligibility among black patients with obstructive sleep apnea (OSA). STUDY DESIGN: Retrospective cohort study. SETTING: Academic tertiary care center. METHODS: Adult patients with OSA who underwent DISE were included. Procedures were performed using a standardized propofol protocol and scored using the Velum, Oropharynx, Tongue base, Epiglottis (VOTE) classification. Patients self-identifying as black or white were analyzed. Demographic, anthropometric, and polysomnographic data were compared using t tests and chi-squared analyses. Logistic regression was performed to determine whether race was independently associated with anterior-posterior (AP) velum collapse after adjusting for covariates. RESULTS: Ninety patients were analyzed (black: n = 20; white: n = 70). Groups were similar in age, sex, body mass index, apnea-hypopnea index, and neck circumference. AP collapse was significantly less common among black than white patients (40% vs 71%, P = .02). In multivariable modeling adjusting for age, sex, body mass index, neck circumference, and pharyngeal opening pressure, black race remained an independently negatively associated with AP collapse (odds ratio 0.09, 95% CI [0.02-0.40], P < .01). CONCLUSION: Black patients were significantly less likely than white patients to exhibit AP velum collapse on DISE, potentially limiting eligibility for HGNS therapy. These findings suggest that racial differences in upper-airway physiology may contribute to disparities in access to surgical treatment for OSA and underscore the need for therapies addressing non-AP collapse phenotypes.