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Future Directions

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The Role of Epiglottis in Obstructive Sleep Apnea

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Abstract

Managing obstructive sleep apnea successfully depends mainly on phenotyping the airway both anatomically (airway collapsibility) and physiologically (like the respiratory drive). Epiglottic collapse may be difficult to treat with conservative therapies, such as oral appliances and CPAP, and has shown to be a predictor of OSA persistence after surgical treatments. DISE is the most commonly used tool for detecting different levels, severities, and patterns of collapse and therefore help direct surgical interventions.

The surgical approaches and tools to manage epiglottic collapse are variable and include the use of diathermy, cold instruments, CO2 laser, coblation, and TORS-assisted partial epiglottectomy. From a technical standpoint, there has been a change from aggressive resection to more preservative techniques. While there is insufficient data on the effect of epiglottis interventions alone, epiglottic collapse may contribute to unsuccessful non-surgical and surgical treatments, therefore identifying cases with this level of collaspse can mitigate management failure.

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References

  1. Benjafield A Eastwood PR, Heinzer RC, Ip MS. Global prevalence of obstructive sleep apnea in adults: estimation using currently available data. In. San Diego, CA 2018.

    Google Scholar 

  2. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev. 2017;34:70–81.

    Article  PubMed  Google Scholar 

  3. Abdelwahab M, Marques S, Previdelli I, Capasso R. Peri-operative antibiotic use in sleep surgery: clinical relevance. Otolaryngol Head Neck Surg. 2021;166:993.

    Article  Google Scholar 

  4. Lyons OD, Bradley TD. Heart failure and sleep apnea. Can J Cardiol. 2015;31(7):898–908.

    Article  Google Scholar 

  5. Ibrahim B, de Freitas Mendonca MI, Gombar S, Callahan A, Jung K, Capasso R. Association of Systemic Diseases with Surgical Treatment for obstructive sleep apnea compared with continuous positive airway pressure. JAMA Otolaryngol Head Neck Surg. 2021;147(4):329–35.

    Article  Google Scholar 

  6. Sapina E, Torres G, Barbe F, Sanchez-de-la-Torre M. The use of precision medicine to manage obstructive sleep apnea treatment in patients with resistant hypertension: current evidence and future directions. Curr Hypertens Rep. 2018;20(7):60.

    Article  PubMed  Google Scholar 

  7. Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352(12):1206–14.

    Article  CAS  PubMed  Google Scholar 

  8. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6(8):e1000132.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee RW, Chan AS, Grunstein RR, Cistulli PA. Craniofacial phenotyping in obstructive sleep apnea--a novel quantitative photographic approach. Sleep. 2009;32(1):37–45.

    PubMed Central  Google Scholar 

  10. Liu KH, Chu WC, To KW, et al. Sonographic measurement of lateral parapharyngeal wall thickness in patients with obstructive sleep apnea. Sleep. 2007;30(11):1503–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Owens RL, Edwards BA, Eckert DJ, et al. An integrative model of physiological traits can be used to predict obstructive sleep apnea and response to non positive airway pressure therapy. Sleep. 2015;38(6):961–70.

    PubMed  PubMed Central  Google Scholar 

  12. Efficacy of Maxillomandibular Advancement Examined with Drug-Induced Sleep Endoscopy and Computational Fluid Dynamics Airflow Modeling 2016.

    Google Scholar 

  13. Liu SYC, Huon LK, Powell NB, et al. Lateral Pharyngeal Wall tension after Maxillomandibular advancement for obstructive sleep apnea is a marker for surgical success: observations from drug-induced sleep endoscopy. J Oral Maxillofac Surg. 2015;73(8):1575–82.

    Article  PubMed  Google Scholar 

  14. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg. 1993;108(2):117–25.

    Article  CAS  PubMed  Google Scholar 

  15. Riley RW, Powell NB, Guilleminault C, Nino-Murcia G. Maxillary, mandibular, and hyoid advancement: an alternative to tracheostomy in obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 1986;94(5):584–8.

    Article  CAS  PubMed  Google Scholar 

  16. Liu SY, Awad M, Riley R, Capasso R. The role of the revised Stanford protocol in Today's precision medicine. Sleep Med Clin. 2019;14(1):99–107.

    Article  PubMed  Google Scholar 

  17. Altintas A, Yegin Y, Celik M, Kaya KH, Koc AK, Kayhan FT. Interobserver consistency of drug-induced sleep endoscopy in diagnosing obstructive sleep apnea using a VOTE classification system. J Craniofac Surg. 2018;29(2):e140–3.

    Article  Google Scholar 

  18. Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol. 2011;268(8):1233–6.

    Article  PubMed  Google Scholar 

  19. Yegin Y, Celik M, Kaya KH, Koc AK, Kayhan FT. Comparison of drug-induced sleep endoscopy and Muller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system. Braz J Otorhinolaryngol. 2017;83(4):445–50.

    Article  PubMed  Google Scholar 

  20. Kent DT, Rogers R, Soose RJ. Drug-induced sedation endoscopy in the evaluation of OSA patients with incomplete Oral appliance therapy response. Otolaryngol Head Neck Surg. 2015;153(2):302–7.

    Article  PubMed  Google Scholar 

  21. Verse T, Pirsig W. Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy. J Laryngol Otol. 1999;113(11):1022–5.

    Article  CAS  PubMed  Google Scholar 

  22. Kezirian EJ. Nonresponders to pharyngeal surgery for obstructive sleep apnea: insights from drug-induced sleep endoscopy. Laryngoscope. 2011;121(6):1320–6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Holzki J, Brown KA, Carroll RG, Cote CJ. The anatomy of the pediatric airway: has our knowledge changed in 120 years? A review of historic and recent investigations of the anatomy of the pediatric larynx. Paediatr Anaesth. 2018;28(1):13–22.

    Article  PubMed  Google Scholar 

  24. Noordzij JP, Ossoff RH. Anatomy and physiology of the larynx. Otolaryngol Clin N Am. 2006;39(1):1–10.

    Article  Google Scholar 

  25. Delakorda M, Ovsenik N. Epiglottis shape as a predictor of obstruction level in patients with sleep apnea. Sleep Breath. 2019;23(1):311–7.

    Article  PubMed  Google Scholar 

  26. Sung CM, Kim HC, Yang HC. The clinical characteristics of patients with an isolate epiglottic collapse. Auris Nasus Larynx. 2020;47(3):450–7.

    Article  PubMed  Google Scholar 

  27. Solomons NB, Prescott CA. Laryngomalacia. A review and the surgical management for severe cases. Int J Pediatr Otorhinolaryngol. 1987;13(1):31–9.

    Article  CAS  PubMed  Google Scholar 

  28. Thorne MC, Garetz SL. Laryngomalacia: review and summary of current clinical practice in 2015. Paediatr Respir Rev. 2016;17:3–8.

    PubMed  Google Scholar 

  29. Sutherland K, Deane SA, Chan AS, et al. Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea. Sleep. 2011;34(4):469–77.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Safiruddin F, Koutsourelakis I, de Vries N. Analysis of the influence of head rotation during drug-induced sleep endoscopy in obstructive sleep apnea. Laryngoscope. 2014;124(9):2195–9.

    Article  PubMed  Google Scholar 

  31. Beelen A, Vonk PE, de Vries N. Drug-induced sleep endoscopy: the effect of different passive maneuvers on the distribution of collapse patterns of the upper airway in obstructive sleep apnea patients. Sleep Breath. 2018;22(4):909–17.

    Article  CAS  Google Scholar 

  32. Vonk PE, Ravesloot MJL, Kasius KM, van Maanen JP, de Vries N. Floppy epiglottis during drug-induced sleep endoscopy: an almost complete resolution by adopting the lateral posture. Sleep Breath. 2020;24(1):103–9.

    Article  CAS  Google Scholar 

  33. Kwon OE, Jung SY, Al-Dilaijan K, Min JY, Lee KH, Kim SW. Is epiglottis surgery necessary for obstructive sleep apnea patients with epiglottis obstruction? Laryngoscope. 2019;129(11):2658–62.

    Article  PubMed  Google Scholar 

  34. Mickelson SA, Rosenthal L. Midline glossectomy and epiglottidectomy for obstructive sleep apnea syndrome. Laryngoscope. 1997;107(5):614–9.

    Article  CAS  PubMed  Google Scholar 

  35. 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;39(6):404–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Safiruddin F, Koutsourelakis I, de Vries N. Upper airway collapse during drug induced sleep endoscopy: head rotation in supine position compared with lateral head and trunk position. Eur Arch Otorhinolaryngol. 2015;272(2):485–8.

    Article  PubMed  Google Scholar 

  37. Victores AJ, Hamblin J, Gilbert J, Switzer C, Takashima M. Usefulness of sleep endoscopy in predicting positional obstructive sleep apnea. Otolaryngol Head Neck Surg. 2014;150(3):487–93.

    Article  PubMed  Google Scholar 

  38. Hybaskova J, Jor O, Novak V, Zelenik K, Matousek P, Kominek P. Drug-induced sleep endoscopy changes the treatment concept in patients with obstructive sleep Apnoea. Biomed Res Int. 2016;2016:6583216.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Arora A, Chaidas K, Garas G, et al. Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment. Sleep Breath. 2016;20(2):739–47.

    Article  PubMed  Google Scholar 

  40. Huang GJ, Luo MS, Chen MZ, Chen GP, Fu MY. Exploration of transoral robotic surgery in the treatment of pediatric obstructive sleep apnea-hypopnea syndrome. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017;31(22):1782–4.

    CAS  Google Scholar 

  41. Lin HS, Rowley JA, Badr MS, et al. Transoral robotic surgery for treatment of obstructive sleep apnea-hypopnea syndrome. Laryngoscope. 2013;123(7):1811–6.

    Article  Google Scholar 

  42. Gazayerli M, Bleibel W, Elhorr A, Maxwell D, Seifeldin R. A correlation between the shape of the epiglottis and obstructive sleep apnea. Surg Endosc. 2006;20(5):836–7.

    Article  CAS  Google Scholar 

  43. Cotton RT, Richardson MA. Congenital laryngeal anomalies. Otolaryngol Clin N Am. 1981;14(1):203–18.

    Article  CAS  Google Scholar 

  44. Faria J, Behar P. Medical and surgical management of congenital laryngomalacia: a case-control study. Otolaryngol Head Neck Surg. 2014;151(5):845–51.

    Article  Google Scholar 

  45. Holinger LD, Konior RJ. Surgical management of severe laryngomalacia. Laryngoscope. 1989;99(2):136–42.

    Article  CAS  Google Scholar 

  46. Kavanagh KT, Babin RW. Endoscopic surgical management for laryngomalacia. Case report and review of the literature. Ann Otol Rhinol Laryngol. 1987;96(6):650–3.

    Article  CAS  Google Scholar 

  47. Lv Y, Huang Q, Lv J, Wu H. Surgical management for severe congenital laryngomalacia: 16 consecutive cases. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013;27(9):475–8.

    Google Scholar 

  48. Richter GT, Thompson DM. The surgical management of laryngomalacia. Otolaryngol Clin N Am. 2008;41(5):837–64. vii

    Article  Google Scholar 

  49. Toynton SC, Saunders MW, Bailey CM. Aryepiglottoplasty for laryngomalacia: 100 consecutive cases. J Laryngol Otol. 2001;115(1):35–8.

    Article  CAS  PubMed  Google Scholar 

  50. Lee CF, Hsu WC, Lee CH, Lin MT, Kang KT. Treatment outcomes of supraglottoplasty for pediatric obstructive sleep apnea: a meta-analysis. Int J Pediatr Otorhinolaryngol. 2016;87:18–27.

    Article  PubMed  Google Scholar 

  51. Martinez-Garcia MA, Capote F, Campos-Rodriguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013;310(22):2407–15.

    Article  CAS  PubMed  Google Scholar 

  52. Penzel T, Riedl M, Gapelyuk A, et al. Effect of CPAP therapy on daytime cardiovascular regulations in patients with obstructive sleep apnea. Comput Biol Med. 2012;42(3):328–34.

    Article  CAS  Google Scholar 

  53. Vlachantoni IT, Dikaiakou E, Antonopoulos CN, Stefanadis C, Daskalopoulou SS, Petridou ET. Effects of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea in arterial stiffness: a meta-analysis. Sleep Med Rev. 2013;17(1):19–28.

    Article  PubMed  Google Scholar 

  54. Dedhia RC, Rosen CA, Soose RJ. What is the role of the larynx in adult obstructive sleep apnea? Laryngoscope. 2014;124(4):1029–34.

    Article  PubMed  Google Scholar 

  55. Shimohata T, Shinoda H, Nakayama H, et al. Daytime hypoxemia, sleep-disordered breathing, and laryngopharyngeal findings in multiple system atrophy. Arch Neurol. 2007;64(6):856–61.

    Article  PubMed  Google Scholar 

  56. Chetty KG, Kadifa F, Berry RB, Mahutte CK. Acquired laryngomalacia as a cause of obstructive sleep apnea. Chest. 1994;106(6):1898–9.

    Article  CAS  Google Scholar 

  57. Andersen AP, Alving J, Lildholdt T, Wulff CH. Obstructive sleep apnea initiated by a lax epiglottis. A contraindication for continuous positive airway pressure. Chest. 1987;91(4):621–3.

    Article  CAS  Google Scholar 

  58. Lin HC, Friedman M, Chang HW, Gurpinar B. The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope. 2008;118(5):902–8.

    Article  PubMed  Google Scholar 

  59. Richard W, Kox D, den Herder C, van Tinteren H, de Vries N. One stage multilevel surgery (uvulopalatopharyngoplasty, hyoid suspension, radiofrequent ablation of the tongue base with/without genioglossus advancement), in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2007;264(4):439–44.

    Article  PubMed  Google Scholar 

  60. Verse T, Baisch A, Maurer JT, Stuck BA, Hormann K. Multilevel surgery for obstructive sleep apnea: short-term results. Otolaryngol Head Neck Surg. 2006;134(4):571–7.

    Article  PubMed  Google Scholar 

  61. Kotecha BT, Hannan SA, Khalil HM, Georgalas C, Bailey P. Sleep nasendoscopy: a 10-year retrospective audit study. Eur Arch Otorhinolaryngol. 2007;264(11):1361–7.

    Article  PubMed  Google Scholar 

  62. Schwab RJ, Gefter WB, Hoffman EA, Gupta KB, Pack AI. Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing. Am Rev Respir Dis. 1993;148(5):1385–400.

    Article  CAS  PubMed  Google Scholar 

  63. Catalfumo FJ, Golz A, Westerman ST, Gilbert LM, Joachims HZ, Goldenberg D. The epiglottis and obstructive sleep apnoea syndrome. J Laryngol Otol. 1998;112(10):940–3.

    Article  CAS  PubMed  Google Scholar 

  64. Kanemaru S, Kojima H, Fukushima H, et al. A case of floppy epiglottis in adult: a simple surgical remedy. Auris Nasus Larynx. 2007;34(3):409–11.

    Article  PubMed  Google Scholar 

  65. Harries PG, Randall CJ. Adult floppy epiglottis: a simple surgical remedy. J Laryngol Otol. 1995;109(9):871–2.

    Article  CAS  PubMed  Google Scholar 

  66. Oluwasanmi AF, Mal RK. Diathermy epiglottectomy: endoscopic technique. J Laryngol Otol. 2001;115(4):289–92.

    Article  CAS  PubMed  Google Scholar 

  67. Golz A, Goldenberg D, Westerman ST, et al. Laser partial epiglottidectomy as a treatment for obstructive sleep apnea and laryngomalacia. Ann Otol Rhinol Laryngol. 2000;109(12 Pt 1):1140–5.

    CAS  PubMed  Google Scholar 

  68. Toh ST, Han HJ, Tay HN, Kiong KL. Transoral robotic surgery for obstructive sleep apnea in Asian patients: a Singapore sleep Centre experience. JAMA Otolaryngol Head Neck Surg. 2014;140(7):624–9.

    Article  PubMed  Google Scholar 

  69. Rastatter JC, Schroeder JW, Hoff SR, Holinger LD. Aspiration before and after Supraglottoplasty regardless of technique. Int J Otolaryngol. 2010;2010:1.

    Article  Google Scholar 

  70. Schroeder JW Jr, Thakkar KH, Poznanovic SA, Holinger LD. Aspiration following CO(2) laser-assisted supraglottoplasty. Int J Pediatr Otorhinolaryngol. 2008;72(7):985–90.

    Article  PubMed  Google Scholar 

  71. Sorrenti G, Piccin O, Mondini S, Ceroni AR. One-phase management of severe obstructive sleep apnea: tongue base reduction with hyoepiglottoplasty plus uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 2006;135(6):906–10.

    Article  Google Scholar 

  72. Bahgat A, Bahgat Y. Robo-cob technique; transoral endoscopic coblation tongue base resection in obstructive sleep apnea patients. Sleep Breath. 2021;25(1):411–5.

    Article  Google Scholar 

  73. Bourolias C, Hajiioannou J, Sobol E, Velegrakis G, Helidonis E. Epiglottis reshaping using CO2 laser: a minimally invasive technique and its potent applications. Head Face Med. 2008;4:15.

    Article  PubMed Central  Google Scholar 

  74. Heiser C, Edenharter G, Bas M, Wirth M, Hofauer B. Palatoglossus coupling in selective upper airway stimulation. Laryngoscope. 2017;127(10):E378–83.

    Article  Google Scholar 

  75. Roger G, Denoyelle F, Triglia JM, Garabedian EN. Severe laryngomalacia: surgical indications and results in 115 patients. Laryngoscope. 1995;105(10):1111–7.

    Article  CAS  Google Scholar 

  76. Zalzal GH, Anon JB, Cotton RT. Epiglottoplasty for the treatment of laryngomalacia. Ann Otol Rhinol Laryngol. 1987;96(1 Pt 1):72–6.

    Article  CAS  PubMed  Google Scholar 

  77. Groblewski JC, Shah RK, Zalzal GH. Microdebrider-assisted supraglottoplasty for laryngomalacia. Ann Otol Rhinol Laryngol. 2009;118(8):592–7.

    Article  PubMed  Google Scholar 

  78. Zalzal GH, Collins WO. Microdebrider-assisted supraglottoplasty. Int J Pediatr Otorhinolaryngol. 2005;69(3):305–9.

    Article  PubMed  Google Scholar 

  79. Seid AB, Park SM, Kearns MJ, Gugenheim S. Laser division of the aryepiglottic folds for severe laryngomalacia. Int J Pediatr Otorhinolaryngol. 1985;10(2):153–8.

    Article  CAS  PubMed  Google Scholar 

  80. Free C, Phillips G, Felix L, Galli L, Patel V, Edwards P. The effectiveness of M-health technologies for improving health and health services: a systematic review protocol. BMC Res Notes. 2010;3:250.

    Article  PubMed Central  Google Scholar 

  81. Yu MS, Ibrahim B, Riley RW, Liu SY. Maxillomandibular advancement and upper airway stimulation: Extrapharyngeal surgery for obstructive sleep apnea. Clin Exp Otorhinolaryngol. 2020;13(3):225–33.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Crinion SJ, Tiron R, Lyon G, et al. Ambulatory detection of sleep apnea using a non-contact biomotion sensor. J Sleep Res. 2020;29(1):e12889.

    Article  Google Scholar 

  83. Genta PR, Sands SA, Butler JP, et al. Airflow shape is associated with the pharyngeal structure causing OSA. Chest. 2017;152(3):537–46.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Azarbarzin A, Marques M, Sands SA, et al. Predicting epiglottic collapse in patients with obstructive sleep apnoea. Eur Respir J. 2017;50(3):1700345.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Sebastian A, Cistulli PA, Cohen G, de Chazal P. Automated identification of the predominant site of upper airway collapse in obstructive sleep apnoea patients using snore signal. Physiol Meas. 2020;41(9):095005.

    Article  PubMed  Google Scholar 

  86. Beeton RJ, Wells I, Ebden P, Whittet HB, Clarke J. Snore site discrimination using statistical moments of free field snoring sounds recorded during sleep nasendoscopy. Physiol Meas. 2007;28(10):1225–36.

    Article  CAS  PubMed  Google Scholar 

  87. Agrawal S, Stone P, McGuinness K, Morris J, Camilleri AE. Sound frequency analysis and the site of snoring in natural and induced sleep. Clin Otolaryngol Allied Sci. 2002;27(3):162–6.

    Article  CAS  PubMed  Google Scholar 

  88. Won TB, Kim SY, Lee WH, et al. Acoustic characteristics of snoring according to obstruction site determined by sleep videofluoroscopy. Acta Otolaryngol. 2012;132(Suppl 1):S13–20.

    Article  Google Scholar 

  89. Rosa T, Bellardi K, Viana A Jr, Ma Y, Capasso R. Digital health and sleep-disordered breathing: a systematic review and meta-analysis. J Clin Sleep Med. 2018;14(9):1605–20.

    Article  PubMed Central  Google Scholar 

  90. Perez-Pozuelo I, Zhai B, Palotti J, et al. The future of sleep health: a data-driven revolution in sleep science and medicine. NPJ Digit Med. 2020;3:42.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Binder S, Baier PC, Molle M, Inostroza M, Born J, Marshall L. Sleep enhances memory consolidation in the hippocampus-dependent object-place recognition task in rats. Neurobiol Learn Mem. 2012;97(2):213–9.

    Article  PubMed  Google Scholar 

  92. Manlises CO, Chen JW, Huang CC. Dynamic tongue area measurements in ultrasound images for adults with obstructive sleep apnea. J Sleep Res. 2020;29(4):e13032.

    Article  PubMed  Google Scholar 

  93. Qian K, Janott C, Pandit V, et al. Classification of the excitation location of snore sounds in the upper airway by acoustic multifeature analysis. IEEE Trans Biomed Eng. 2017;64(8):1731–41.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sleep Surgery Division, Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA

    Mohamed Abdelwahab

  2. Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Mansoura University, Mansoura, Egypt

    Rakha Abdelwahab

  3. Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, CA, USA

    Robson Capasso

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  1. Mohamed Abdelwahab
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  2. Rakha Abdelwahab
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  3. Robson Capasso
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Correspondence to Robson Capasso .

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  1. General Hospital Celje, Celje, Slovenia

    Matej Delakorda

  2. Jan Tooropstraat, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Nico de Vries

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Abdelwahab, M., Abdelwahab, R., Capasso, R. (2023). Future Directions. In: Delakorda, M., de Vries, N. (eds) The Role of Epiglottis in Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-031-34992-8_27

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