Impact of Mask Type on Pharyngeal Opening Pressures During Drug‐Induced Sleep Endoscopy

ABSTRACT

Objective

Positive airway pressure applied during drug‐induced sleep endoscopy (DISE‐PAP) can aid in surgical planning for the management of obstructive sleep apnea (OSA). Studies examining the effect of mask type during DISE‐PAP are currently limited. Based on prior literature, we hypothesize that patients undergoing DISE‐PAP with nasal masks will experience reduced pharyngeal opening pressures (PhOPs) compared to full‐face mask techniques.

Methods

Adult patients undergoing DISE‐PAP with three mask types (nasal, full‐face, and full‐face masks with mouth closure and teeth in occlusion) from April 2024 to November 2024 were retrospectively reviewed. PhOPs (cmH₂O) were evaluated by mask type and anatomical location (velum, oropharynx, tongue base, epiglottis). Matched‐pairs Friedman tests, unmatched Kruskal–Wallis tests, and multiple comparisons testing were utilized to assess PhOPs. Statistical significance was defined as p < 0.05.

Results

Fifty‐six patients met the inclusion criteria. Median PhOP significantly differed for nasal, full‐face, and full‐face masks with mouth closure and teeth occlusion, respectively, at the velum (6 vs. 10 vs. 7.5 cmH₂O, p < 0.0001), oropharynx (7.5 vs. 13 vs. 10 cmH₂O, p < 0.0001), and tongue base (7 vs. 9.5 vs. 7 cmH₂O, p < 0.0001). Multiple comparisons testing demonstrated reduced median pressures for nasal vs. full‐face masks at all sites (p < 0.05) and reduced pressures for full‐face masks with mouth closure and teeth occlusion at the velum and oropharynx (p < 0.05).

Conclusion

Nasal masks led to reduced PhOP levels compared to full‐face masks during DISE‐PAP. Further study of DISE‐PAP mask techniques is necessary given the recent association of PhOP with patient characteristics and sleep surgery success.

Level of Evidence

3.

Assessment of the impact of mask type on pharyngeal opening pressures during drug‐induced sleep endoscopy (DISE) is currently lacking. Our study demonstrates that pharyngeal opening pressures at the velum, oropharynx, and tongue base are significantly reduced using nasal vs. full‐face mask techniques. These findings are important given recent associations of pharyngeal opening pressures during DISE with patient characteristics and sleep surgery success.

1. Introduction

Obstructive sleep apnea (OSA) is a highly prevalent condition characterized by intermittent partial to complete upper airway collapse occurring throughout sleep [1]. Patients with OSA are subject to negative effects on quality of life, as well as cardiovascular and psychosocial morbidity [2, 3]. The first‐line treatment approach to OSA includes continuous positive airway pressure (CPAP), which has been shown to positively affect blood pressure, daytime sleepiness, cognitive performance, and overall quality of life [4]. Operative approaches to patients with moderate to severe OSA may be employed in the setting of CPAP nonadherence or intolerance and include pharyngeal, facial skeletal, and hypoglossal nerve stimulation (HGNS) surgeries [5, 6].

The surgical candidacy of patients with OSA is often determined using drug‐induced sleep endoscopy (DISE). Through DISE, anatomic sites of collapse (velum, oropharynx, tongue base, and epiglottis), patterns of upper airway obstruction (anteroposterior, lateral, or concentric), and degree of obstruction (non‐obstructed, partial, or complete) are evaluated under sedation to mimic the sleeping state [7]. Positive airway pressure administered during DISE (DISE‐PAP) allows for evaluation of the therapeutic effect of PAP and visualization of airway opening [8, 9]. Importantly, the optimal mask technique for PAP application during DISE has not been defined.

Prior CPAP literature has shown mixed results when examining the effect of different mask types, including nasal and oronasal (full‐face) apparatuses. Most studies report that nasal masks result in a reduced PAP requirement to relieve airway obstruction when compared to full‐face masks; however, some groups have found no significant difference [10, 11, 12, 13, 14]. The impact of mask type utilized during DISE‐PAP has been previously evaluated, although the current literature is limited to individual case reports and smaller‐scale cohort studies [15, 16, 17, 18, 19]. Such work is important for optimizing the consistency of findings obtained through DISE. Pharyngeal opening pressures (PhOP) during DISE have been linked to the success of HGNS therapy, with one prior study reporting a palatal opening pressure of 8 cmH₂O or lower as a positive predictor of HGNS response [20]. Our study aims to assess how different PAP mask types used during DISE impact PhOP in patients with OSA. Based on prior literature, we hypothesize that nasal masks will result in lower PhOP thresholds when compared to full‐face mask techniques.

2. Methods

2.1. Study Design and Institutional Approval

This study is a single‐institution retrospective review of patients with OSA undergoing DISE for surgical planning. All included patients were evaluated with DISE‐PAP to determine anatomic opening pressures (cmH₂O) at the velum, oropharynx, tongue base, and epiglottis during their procedure through three masking types: nasal mask, full‐face mask, and full‐face mask with the mouth closed and teeth in occlusion. Patients were included in the study if they underwent DISE in the described time period and received PAP using the three distinct masking techniques. Patients were thus excluded if not all masking types were utilized or if clinical documentation did not include the totality of DISE‐PAP findings. A breakdown of our final study cohort (n = 56) can be found in Figure 1. Approval of the study was granted after evaluation by the Institutional Review Board at Thomas Jefferson University (Control #2023–2651).

FIGURE 1.

Study cohort inclusion map. DISE‐PAP, drug‐induced sleep endoscopy with positive airway pressure.

2.2. DISE Protocol

Following arrival in the preoperative holding area, intravenous access is established and oxymetazoline is administered to promote nasal vasoconstriction and decongestion. At our institution, DISE is performed in either the operating room or endoscopy suite [21]. Patients undergo DISE after sedation with propofol unless an allergy is specified. Propofol is continuously infused with supplementation by a propofol bolus to achieve a level of sedation in which the respiratory drive is maintained, but there is no reaction to the nasal insertion of the camera, presence of swallowing, or cough. Depth of anesthesia using bispectral index (BIS) monitoring is not routinely utilized during intravenous anesthesia cases at our institution due to lack of necessity and added procedural cost [22]. Following camera insertion, anatomic sites, including the velum, oropharynx, tongue base, and epiglottis, are evaluated for the magnitude of airway collapse under direct visualization with nasopharyngoscopy. For patients of this study, visualization of these sites was then repeated with DISE‐PAP using a nasal mask, full‐face mask, and finally, a full‐face mask with the patient's mouth closed and teeth in occlusion. It is not standard practice at our institution to perform these three mask techniques on all patients undergoing DISE. This protocol addition was employed in part to optimize DISE masking during PAP for future practice. The same sequential order of mask type was used for all included patients. Nasal and full‐face masks were secured to the face using standard headgear. For the full‐face mask with mouth closure and teeth in occlusion, the mask remained secured by standard headgear and gentle digital mandibular pressure was applied to maintain teeth occlusion without manipulating head position throughout the PAP application. Mask adjustments were made to ensure that any air leak was below 25 L/min [23]. A starting pressure of 5 cmH₂O with incremental pressure increases to 15 cmH₂O over a 5‐min period to determine opening pressures was utilized. Pressure is increased gradually over the 5‐min period with approximately 30 s per each single‐digit elevation in PAP level. The pressure range of 5–15 cmH₂O is used at our institution as it mirrors the auto‐titration range employed when patients are initiated on CPAP therapy. This differs from pressure ramp ranges previously published in the literature from 4 to 18 or 20 cmH₂O [8, 20]. Opening pressure thresholds were determined through a combination of both visual and haptic evaluation. Visually, the patient was assessed for minimal stable airway patency, and haptically, the patient was assessed for lack of palpable vibration secondary to snoring at the given anatomic site. Following DISE‐PAP, sedation is weaned, and the procedure is completed with the patient transitioning to the recovery area.

2.3. Data Collection

All study data was obtained from the review of the electronic medical record (EMR). Surgical schedules of two board‐certified sleep surgeons (M.S.B. and C.T.H.) were retrospectively evaluated for patients undergoing DISE from April 2024 to November 2024. Data collection included patient sex, age, self‐reported race, body mass index (BMI), preoperative apnea–hypopnea index (AHI), or respiratory event index (REI), and type of preoperative sleep study (home sleep study [HST] or attended in‐lab polysomnography [PSG]). Operative notes from the day of DISE included the level of collapse at the four anatomic locations assessed. In addition, airway opening pressure thresholds at these sites were evaluated when using the three defined masking techniques.

2.4. Statistical Analysis

Continuous variables were analyzed using nonparametric matched‐pairs Friedman tests and nonparametric unmatched Kruskal–Wallis tests. Multiple comparison testing between the different masking types and subsites was performed using Dunn's tests. The distribution of datasets was evaluated for normality using Shapiro–Wilk tests. Confidence intervals (95%) were calculated and are reported for comparisons of medians. Descriptive statistics were collected and summarized for patient demographic data. All statistical analyses were performed using GraphPad Prism (version 10.4.1), with statistical significance defined as p < 0.05.

3. Results

3.1. Cohort Demographics and Sleep Data

A total of 56 patients underwent DISE, including DISE‐PAP evaluation with the three distinct masking techniques, and were thus included in the analysis. The cohort demonstrated a mean age of 58.5 years, a mean BMI of 30.1 kg/m², and a predominance of Caucasian (82.1%) and male (69.6%) patients. Regarding preoperative sleep study data, most patients underwent an HST (74.5%), and the average patient demonstrated severe sleep apnea with a mean AHI/REI of 31.0 and O₂ nadir of 76.8%. The distribution of OSA severity was highest for moderate disease (49.1%), followed by severe (45.5%) and mild (5.4%) disease. Median scores during DISE were as follows: velum (2), oropharynx (1), tongue base (2), and epiglottis (0). These data are summarized in Table 1.

TABLE 1.

Cohort characteristics and median DISE scores.

Age (years)	58.5 ± 12.7
BMI (kg/m2)	30.1 ± 3.8
Sex
Male	39 (69.6)
Female	17 (30.4)
Race
Caucasian	46 (82.1)
African American	7 (12.5)
Hispanic	2 (3.6)
Not reported	1 (1.8)
Preoperative sleep study type
HST	41 (74.5)
PSG	14 (25.5)
AHI/REI	31.0 ± 14.7
OSA severity
Mild	3 (5.4)
Moderate	27 (49.1)
Severe	25 (45.5)
O2 Nadir (%)	76.8 ± 7.0
Median DISE score
Velum	2
Oropharynx	1
Tongue Base	2
Epiglottis	0

Note: Data are mean ± standard deviation, N (percentage), or median. Sleep study data was available for 55 of 56 patients.

Abbreviations: AHI, apnea–hypopnea index; BMI, body mass index; DISE, drug‐induced sleep endoscopy; HST, home sleep test; O₂, oxygen; OSA, obstructive sleep apnea; PSG, polysomnography; REI, respiratory event index.

3.2. Pharyngeal Opening Pressures

Pharyngeal opening pressures were calculated using nasal masks, full‐face masks, and full‐face masks with mouth closure and teeth occlusion at the velum, oropharynx, and tongue base for patients with identified obstruction at these sites. Minimal epiglottic collapse was identified, and pressures at this site are thus not reported in this manuscript. Following matched‐pairs Friedman tests, median opening pressures significantly differed at the velum for nasal masks, full‐face masks, and full‐face masks with mouth closure and teeth occlusion, respectively (6 vs. 10 vs. 7.5 cmH₂O, p < 0.0001). Similarly, median opening pressures for the three masking types differed at the oropharynx (7.5 vs. 13 vs. 10 cmH₂O, p < 0.0001) and tongue base (7 vs. 9.5 vs. 7 cmH₂O, p < 0.0001). These data are summarized in Table 2. Compared to nasal masks, full‐face masks resulted in increased PhOP levels for most patients at the velum (94.3%, n = 50/53), oropharynx (100%, n = 27/27), and tongue base (86.3%, n = 44/51). Compared to full‐face masks alone, the addition of mouth closure with teeth occlusion resulted in improved PhOP thresholds for most patients at the velum (71.7%, n = 38/53), oropharynx (74.1%, n = 20/27), and tongue base (66.7%, n = 34/51).

TABLE 2.

Friedman test comparisons of median opening pressures per subsite by masking type.

Anatomical subsite	Nasal mask	Full‐face mask	Full‐face mask + mouth closure with occlusion	p
Velum (n = 53)	6 [6.00–6.79]	10 [9.58–11.1]	7.5 [7.38–8.37]	< 0.0001
Oropharynx (n = 27)	7.5 [7.34–9.22]	13 [11.67–13.52]	10 [9.04–11.36]	< 0.0001
Tongue Base (n = 51)	7 [6.74–7.63]	9.5 [9.11–10.46]	7 [7.03–7.82]	< 0.0001

Note: Data are median opening pressure (cmH₂O) [95% confidence interval]. Statistically significant findings are in bold.

Following unmatched Kruskal–Wallis tests, median opening pressures differed at the velum, oropharynx, and tongue base, respectively, using nasal masks (6 vs. 7.5 vs. 7, p < 0.0001). Median opening pressures also significantly differed at the velum, oropharynx, and tongue base, respectively, using both full‐face masks (10 vs. 13 vs. 9.5 cmH₂O, p < 0.0001) and full‐face masks with mouth closure and teeth occlusion (7.5 vs. 10 vs. 7 cmH₂O, p < 0.0001). These data are summarized in Table 3.

TABLE 3.

Kruskal–Wallis test comparisons of median opening pressures per masking type by subsite.

Anatomical subsite	Velum (n = 53)	Oropharynx (n = 27)	Tongue base (n = 51)	p
Nasal mask	6 [6.00–6.79]	7.5 [7.34–9.22]	7 [6.74–7.63]	< 0.0001
Full‐face mask	10 [9.58–11.1]	13 [11.67–13.52]	9.5 [9.11–10.46]	< 0.0001
Full‐face mask + mouth closure with occlusion	7.5 [7.38–8.37]	10 [9.04–11.36]	7 [7.03–7.82]	< 0.0001

Note: Data are median opening pressure (cmH₂O) [95% confidence interval]. Statistically significant findings are in bold.

Multiple comparisons testing was performed to assess median PhOP values per subsite by mask type, in which each individual group was compared to each other using the Dunn's test. At the velum, nasal masks led to reduced median pressures when compared to full‐face masks (6 vs. 10 cmH₂O, p < 0.0001) and full‐face masks with mouth closure and teeth in occlusion (6 vs. 7.5 cmH₂O, p = 0.0005). Full‐face masks alone resulted in higher opening pressures compared to full‐face masks with mouth closure and teeth in occlusion at the velum (10 vs. 7.5 cmH₂O, p < 0.0001). At the oropharynx, nasal masks led to reduced median pressures when compared to full‐face masks (7.5 vs. 13 cmH₂O, p < 0.0001) and full‐face masks with teeth occlusion (7.5 vs. 10 cmH₂O, p = 0.036). Full‐face masks alone yielded elevated higher opening pressures compared to full‐face masks with mouth closure and teeth in occlusion at the oropharynx (13 vs. 10 cmH₂O, p = 0.0012). Finally, at the tongue base, nasal masks led to reduced median pressures when compared to full‐face masks alone (7 vs. 9.5 cmH₂O, p < 0.0001), but not with concurrent mouth closure and teeth occlusion. Full‐face masking with mouth closure and teeth occlusion also resulted in reduced median opening pressures at the tongue base compared to full‐face masks alone (7 vs. 9.5 cmH₂O, p < 0.0001). These data can be visualized graphically in Figure 2.

FIGURE 2.

Multiple comparisons testing of median pharyngeal opening pressures per anatomic location by mask type. Data are median with 95% confidence intervals (error bars). *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001, ns (not significant). [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

In addition, multiple comparisons testing was performed to compare median PhOP values per mask type by subsite, also using the Dunn's test. Nasal masks yielded median PhOP values that were reduced at the velum compared to the oropharynx (6 vs. 7.5 cmH₂O, p < 0.0001) and tongue base (6 vs. 7 cmH₂O, p = 0.0029). Full‐face masks alone resulted in reduced median PhOP levels at the velum compared to the oropharynx (10 vs. 13 cmH₂O, p = 0.0011) and at the tongue base compared to the oropharynx (9.5 vs. 13 cmH₂O, p < 0.0001). Like full‐face masks alone, the addition of mouth closure with occlusion also yielded reduced velum and tongue base PhOP levels compared to the oropharynx (p = 0.002 and p < 0.0001, respectively). These data can be visualized graphically in Figure 3.

FIGURE 3.

Multiple comparisons testing of median pharyngeal opening pressures per mask type by anatomic location. Data are median with 95% confidence intervals (error bars). **p < 0.01, ****p < 0.0001, ns (not significant). [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

4. Discussion

Despite criticism of DISE, it remains an important component of surgical planning and optimization for patients with CPAP‐intolerant OSA [7]. The addition of DISE‐PAP during this procedure may improve the utility of DISE by giving surgeons the opportunity to assess the pressure required for airway opening and, in some cases, directly visualize areas of collapse leading to residual obstructive events, even in patients with appropriate CPAP implementation [9, 24]. The mask type utilized during DISE‐PAP is an important consideration, as it is vital to promote consistency from both patient care and research perspectives, especially if they result in significantly different pressure findings. However, prior work examining the effect of mask type on PhOP during DISE remains limited. This study retrospectively evaluated 56 patients undergoing DISE with PAP application using three different mask iterations, including nasal masks, full‐face masks, and full‐face masks with the mouth closed and teeth in occlusion, to determine if opening pressures differed based on mask type. We found that mask type resulted in significantly different median PhOP during DISE‐PAP at the velum, oropharynx, and tongue base in our patient cohort. Specifically, nasal masks yielded significantly reduced median pressures at all these three anatomical sites compared to full‐face masks alone and reduced median pressures at the velum and oropharynx compared to full‐face masks with mouth closure and teeth occlusion. The addition of mouth closure and occlusion to full‐face masks led to reduced median pressures at all three sites compared to full‐face masks alone. Nasal masks yielded reduced PhOP thresholds at the velum compared to the oropharynx and tongue base, while full‐face masks with or without mouth closure and teeth occlusion resulted in lessened PhOP thresholds at the velum and tongue base compared to the oropharynx.

Variations in mask type have been previously assessed for differences in therapeutic PAP levels and are reported throughout the literature with mixed outcomes. In an assessment of 358 CPAP implementation studies with either nasal (35%), oronasal (46%), or nasal pillow (19%) masks, Deshpande et al. found that the median CPAP level was highest for oronasal masks (12 cmH₂O), followed by nasal pillow (11 cmH₂O) and nasal (10 cmH₂O) masks. In addition, in patients with CPAP requirements of at least 15 cmH₂O, an odds ratio of 4.5 was evident for having an oronasal versus any nasal‐type mask [12]. Bettinzoli et al. retrospectively compared nasal vs. oronasal masks during auto‐titrating CPAP administration in 109 patients to evaluate CPAP levels and residual AHI. This group reported a significant 1.2 cmH₂O reduction in the nasal mask cohort, as well as a significantly lower residual AHI [25]. Andrade et al. performed a systematic review and meta‐analysis comprised of 13 trials with 4583 collective patients to compare outcomes with nasal and oronasal masks. This group reported that nasal masks were associated with significantly reduced CPAP levels (mean of −1.5 cmH₂O) and residual AHI, as well as improved PAP adherence [14]. Hypothesized reasons for the demonstrated effect on PAP requirements through nasal masks include airway narrowing and posterior mandible displacement that occurs with oronasal masks [11, 26]. Furthermore, nasal masks may more effectively splint the upper airway by pushing the soft palate anteriorly against the tongue, while oronasal masks diminish this benefit via positive pressure through the mouth [27]. Conversely, a subset of smaller studies have reported that PAP levels may not significantly change based on mask type [10, 13].

PhOPs visualized during DISE‐PAP have important implications and have been associated with OSA patient characteristics and sleep surgery outcomes. Seay et al. performed a prospective study of 27 patients undergoing DISE with PAP application through nasal masks. This cohort was stratified based on their response level to eventual HGNS therapy and was classified as either responders (n = 18) or non‐responders (n = 9). Responders, on average, demonstrated a 3.5 cmH₂O lower opening pressure at the palate. Following postoperative efficacy studies, it was determined that a palatal opening pressure cutoff level of 8 cmH₂O corresponded with an 82.4% positive predictive value of HGNS response [20]. Parekh et al. performed a cross‐sectional study of 164 patients who underwent DISE‐PAP with nasal masks in which a PhOP was defined per patient. Subsequent analysis showed that higher PhOP was associated with younger age, elevated BMI, and higher snoring scores. Reported PhOP was also associated with overall AHI, supine AHI, and O₂ nadir levels [28]. Furthermore, the impact of breathing type (nasal or mouth breathing) has been previously assessed in OSA patients. A nonrandomized trial of 54 patients demonstrated that inspiratory flow amounts during DISE with oronasal masks depend on baseline breathing type. In this cohort, 22% of patients experienced worsened airflow with mouth closure [29]. This finding is consistent with our reported results at the velum, oropharynx, and tongue base, where mouth closure with teeth occlusion improved PhOP values for approximately 70% of patients, emphasizing the importance of baseline breathing type on a per‐patient basis.

Evaluation of altering mask type and the resultant effect on PhOPs during sleep endoscopy has been previously reported mainly through small case and cohort studies. A case report of a 69‐year‐old patient with severe OSA included nasal and oronasal mask use during sleep endoscopy in which pharyngeal collapse was relieved at 7 cmH₂O with nasal PAP application; however, persistence of collapse was present after oronasal PAP application at 16 cmH₂O [16]. Lee et al. described a 60‐year‐old female with noted soft palate collapse and posterior tongue displacement at 12 cmH₂O administered through an oronasal mask. Subsequent PAP application at a lower level through a nasal mask resulted in soft palate patency without displacement of the tongue [17]. Separately, Harkins et al. described a 71‐year‐old male that experienced resolution of tongue base collapse at low‐pressure levels using a nasal mask during DISE‐PAP, for which the minimum therapeutic PAP level was increased after an oronasal mask was introduced [18]. At the same applied PAP level, nasal masks were shown to improve obstruction scores at the velum, oropharynx, and in total as compared to oronasal masks in a prospective study of 13 patients [15]. Furthermore, prior work has expanded beyond PAP application during DISE to include further testing and patient evaluation with imaging modalities and airway apparatuses. These studies have included measurement of soft tissue, airway, and skeletal volume on computed tomography to correlate with PhOP, assessment of hyoid bone motion on ultrasound as relating to AHI and level of PAP administration during DISE, and evaluation of how the placement of nasopharyngeal tubes impacts multilevel obstruction observed through sleep endoscopy [30, 31, 32]. As additional studies are carried out using DISE‐PAP with and without further intervention in efforts to better define sleep surgery outcomes and patient characteristics, consistency regarding masking techniques during such procedures is vital.

The current study and reported data are subject to certain limitations. Given our retrospective design, we are unable to definitively conclude that certain PAP mask types or techniques result in altered PhOP levels. Despite this, we believe that the ability to make matched‐pair comparisons within the same individual patient strengthens the validity of our findings. In addition, DISE results inherently possess a level of subjectiveness that may limit reproducibility, and our study did not include blinding of DISE videos for PhOP determination. However, we believe that the same surgeon evaluating the three mask scenarios on a per‐patient basis helps to reduce such bias. As mentioned above, BIS is not typically utilized during DISE at our institution, and thus, we cannot confirm with certainty that slight differences in the plane of sedation did not occur and thus impact our results. Furthermore, the same sequential order of mask type was utilized per patient during DISE‐PAP, and as a result, nasal masking would theoretically have been subject to the lowest amount of propofol sedation on a per‐patient basis. To reduce bias, the mask order should be randomized in any future prospective studies of this type. In addition, our study may have benefited from strict standardization of mask tightness using headgear and investigator stabilization during mouth closure, as overtightening of PAP masks can lead to mandible retrodisplacement. Our DISE‐PAP pressure ramp of 5–15 cmH₂O deviates slightly from previously published literature and may result in an overestimation of PhOP in select patients with immediate pharyngeal opening and may have a true PhOP of less than 5 cmH₂O or underestimation of PhOP in patients with true pressure requirements of > 15 cmH₂O. In assessing our cohort, most patients were Caucasian males and experienced moderate‐to‐severe OSA. This could be improved upon in future studies by including additional female patients and those with mild disease to improve generalizability. A prospective study of a larger randomized patient sample size may strengthen the results of the current report and is worthwhile to better define the impact of mask type on PhOP during DISE‐PAP.

5. Conclusions

Nasal masks are associated with reduced PhOPs compared to full‐face mask techniques during DISE‐PAP. Given the growing body of literature linking DISE‐PAP findings with OSA patient characteristics and the success of sleep surgery, standardization of mask type during DISE may be appropriate. Further work examining mask techniques utilized during DISE‐PAP for patients with OSA is warranted.

Conflicts of Interest

Maurits Boon is chief medical officer of Nyxoah SA. Colin Huntley holds research support from Inspire Medical and Nyxoah SA and has a consulting relationship with Inspire Medical, Nyxoah SA, and Avivomed. The other authors declare no conflicts of interest.

Estephan L. E., Creighton E., Platukus A., et al., “Impact of Mask Type on Pharyngeal Opening Pressures During Drug‐Induced Sleep Endoscopy,” The Laryngoscope 135, no. 12 (2025): 4976–4982, 10.1002/lary.32395.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.