Awake endoscopic assessment of the upper airway during tidal breathing: Definition of anatomical features and comparison with drug‐induced sleep endoscopy

Objectives Awake nasopharyngoscopy is routinely performed in the assessment of patients who require treatment for sleep‐disordered breathing (SDB). However, the applicability and accuracy of Müller's manoeuvre, the main evaluation method for this purpose, are disputable. The current study aimed to introduce an alternative method for awake nasopharyngoscopy in patients with SDB. Design We defined qualitative anatomical features during tidal breathing at the levels of the soft palate, oropharynx, tongue base, epiglottis and hypopharynx, and compared these awake features to the sites and patterns of collapse as observed during drug‐induced sleep endoscopy (DISE). Setting Tertiary care academic centre. Participants Seventy‐three patients diagnosed with SDB. Main outcome measures The primary outcome measure was the Kendall's tau correlation coefficient (τ) between observations during awake nasopharyngoscopy and DISE. Kappa‐statistics (κ) were calculated to assess the agreement on awake endoscopic features with a second observer. Results In contrast to epiglottis shape, the modified Cormack‐Lehane scale was significantly associated with epiglottis collapse during DISE (P