Is VOTE enough to guide therapy? A prospective study on phenotypic characterization
DOI:
https://doi.org/10.34631/sporl.3112Keywords:
Obstructive Sleep Apnea (OSA), Phenotype, Airway Obstruction, Drug-Induced Sleep Endoscopy (DISE), VOTE ClassificationAbstract
Objective: To demonstrate the heterogeneity within the VOTE classification through an extended phenotypic assessment based on iconographic documentation obtained during DISE.
Study Design: Prospective observational study.
Material and Methods: DISE was evaluated using the VOTE classification, along with palatal morphology, subjective pharyngeal airway dimensions, collapse patterns at the palatal genu, velum, upper and lower tongue base, and epiglottis, and lingual tonsil grading (Friedman).
Results: Fifty patients were included (mean age 47.2 ± 8.4 years; 68% male), 35 of whom had confirmed OSA. Significant phenotypic heterogeneity was observed among patients with similar VOTE classification.
Conclusions: The VOTE classification alone may underestimate the anatomical and functional complexity observed in DISE. Detailed phenotypic characterization is essential for individualized therapeutic planning in cases of snoring and OSA.
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Croft C, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clinical Otolaryngology & Allied Sciences. 1991;16(5):504-9. DOI: 10.1111/j.1365-2273.1991.tb02103.x
De Vito A, Woodson BT, Koka V, Cammaroto G, Iannella G, Bosi M, et al. OSA upper airways surgery: A targeted approach. Medicina. 2021;57(7):690. DOI: 10.3390/medicina57070690
Hsu Y-S, Jacobowitz O. Does sleep endoscopy staging pattern correlate with outcome of advanced palatopharyngoplasty for moderate to severe obstructive sleep apnea? Journal of Clinical Sleep Medicine. 2017;13(10):1137-44. DOI: 10.5664/jcsm.6756
Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol. 2011 Aug;268(8):1233-1236. doi: 10.1007/s00405-011-1633-8
Woodson BT. A method to describe the pharyngeal airway. The Laryngoscope. 2015;125(5):1233-8. DOI: 10.1002/lary.24972
De Vito A, Carrasco Llatas M, Ravesloot MJ, Kotecha B, De Vries N, Hamans E. et al. European position paper on drug‐induced sleep endoscopy: 2017 update. Clin Otolaryngol. 2018 Dec;43(6):1541-1552. doi: 10.1111/coa.13213.
De Vito A, Olszewska E, Kotecha B, Thuler E, Casale M, Cammaroto G. et al. A critical analysis of pharyngeal patterns of collapse in obstructive sleep apnea: beyond the endoscopic classification systems. J Clin Med. 2023 Dec 27;13(1):165. doi: 10.3390/jcm13010165.
Olszewska E, Woodson BT. Palatal anatomy for sleep apnea surgery. Laryngoscope Investig Otolaryngol. 2019 Jan 10;4(1):181-187. doi: 10.1002/lio2.238.
Friedman M, Yalamanchali S, Gorelick G, Joseph NJ, Hwang MS. A standardized lingual tonsil grading system: interexaminer agreement. Otolaryngol Head Neck Surg. 2015 Apr;152(4):667-72. doi: 10.1177/0194599815568970.
De Vito A, Olszewska E, Kotecha B, Thuler E, Casale M, Cammaroto G. et al. A critical analysis of pharyngeal patterns of collapse in obstructive sleep apnea: beyond the endoscopic classification systems. J Clin Med. 2023 Dec 27;13(1):165. doi: 10.3390/jcm13010165.
Olszewska E, Woodson BT. Palatal anatomy for sleep apnea surgery. Laryngoscope Investig Otolaryngol. 2019 Jan 10;4(1):181-187. doi: 10.1002/lio2.238.
Kedarisetty S, Sharma A, Commesso EA, Woodson BT, Huyett P, Kent DT. et al. Palate shape is associated with unilateral hypoglossal nerve stimulation outcomes. Laryngoscope. 2024 Feb;134(2):981-986. doi: 10.1002/lary.31018.
Zhang P, Ye J, Pan C, Sun N, Kang D. The role of obstruction length and height in predicting outcome of velopharyngeal surgery. Otolaryngol Head Neck Surg. 2015 Jul;153(1):144-9. doi: 10.1177/0194599815576719.
Commesso EA, Kedarisetty S, Kita AE, Sharma A, Woodson BT, Green KK. et al. Palate shape, drug-induced sleep endoscopy findings, and obstructive sleep apnea pharyngeal surgery outcomes. Otolaryngol Head Neck Surg. 2024 Sep;171(3):902-909. doi: 10.1002/ohn.849.
Elsobki A, Elshaer M, Ghabn H, El-Deeb ME, Suliman L. Transoral drug-induced sleep endoscopy: a useful complementary tool in sleep surgery. Int Arch Otorhinolaryngol. 2025 Jan 10;29(1):1-8. doi: 10.1055/s-0044-1788768.
Krespi YP, Har-El G, Levine TM, Ossoff RH, Wurster CF, Paulsen JW. Laser lingual tonsillectomy. Laryngoscope. 1989 Feb;99(2):131-5. doi: 10.1288/00005537-198902000-00003.
Miller SC, Nguyen SA, Ong AA, Gillespie MB. Transoral robotic base of tongue reduction for obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope. 2017 Jan;127(1):258-265. doi: 10.1002/lary.26060.
Woodson BT, Fujita S. Clinical experience with lingualplasty as part of the treatment of severe obstructive sleep apnea. Otolaryngol Head Neck Surg. 1992 Jul;107(1):40-8. doi: 10.1177/019459989210700107.
Arens P, Hansel T, Wang Y. Hypoglossal nerve stimulation therapy. Adv Exp Med Biol. 2022:1384:351-372. doi: 10.1007/978-3-031-06413-5_21.
Cheng A. Genioglossus and genioplasty advancement. Atlas Oral Maxillofac Surg Clin North Am. 2019 Mar;27(1):23-28. doi: 10.1016/j.cxom.2018.11.008.
Handler E, Hamans E, Goldberg AN, Mickelson S. Tongue suspension: an evidence-based review and comparison to hypopharyngeal surgery for OSA. Laryngoscope. 2014 Jan;124(1):329-36. doi: 10.1002/lary.24187
Salamanca F, Leone F, Bianchi A, Bellotto RGS, Costantini F, Salvatori P. Surgical treatment of epiglottis collapse in obstructive sleep apnoea syndrome: epiglottis stiffening operation. Acta Otorhinolaryngol Ital. 2019 Dec;39(6):404-408. doi: 10.14639/0392-100X-N0287.
Vallianou K, Chaidas K. Surgical treatment options for epiglottic collapse in adult obstructive sleep apnoea: a systematic review. Life (Basel). 2022 Nov 11;12(11):1845. doi: 10.3390/life12111845.
Nunes HDSS, Vaz de Castro J, Favier V, Carsuzaa F, Kim MHR, Mira FA. et al. Predictors of success of pharyngeal surgery in the treatment of obstructive sleep apnea: a narrative review. J Clin Med. 2023 Oct 26;12(21):6773. doi: 10.3390/jcm12216773.
Choi JH, Cho SH, Kim SN, Suh JD, Cho JH. Predicting outcomes after uvulopalatopharyngoplasty for adult obstructive sleep apnea: a meta-analysis. Otolaryngol Head Neck Surg. 2016 Dec;155(6):904-913. doi: 10.1177/0194599816661481.
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Copyright (c) 2025 Maria Marques da Silva, António Andrade, Sónia Pires Martins, Ricardo Vaz, Jorge Rodrigues, João Viana Pinto
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