Race Based Differences in VOTE Findings Influencing Upper Airway Stimulation Implant Rates

Introduction: Upper airway stimulation (UAS) is a surgical treatment for obstructive sleep apnea, but ADHERE registry data reveal racial disparities, with only 4.6% of recipients being non-White. Factors including socioeconomic influences, healthcare access, and patient awareness may contribute to this inequity. Moreover, eligibility for therapy requires anterior-posterior (AP) collapse at the velum on drug induced sleep endoscopy (DISE), and we hypothesize that Black patients have lower rates of AP collapse, leading to higher rates of ineligibility for this treatment.

Methods: This analysis utilizes previously collected data from an ongoing study approved by Emory University’s IRB (STUDY00003579). OSA patients underwent DISE using routine clinical protocol. Upper airway (UA) assessment during sedation was performed by a surgeon (JLY) and classified using VOTE criteria, which was obtained from notes on procedure day. Self-reported race data was collected from subject charts, and those reporting multiple races were excluded to ensure accuracy in the analysis.

Results: Between July 2022 and December 2024, 89 patients had DISE performed with 82 patients identifying as Black (n = 18, 21.95%) or White (n = 64, 78.05%). 56% (n = 10) of Black patients were men compared to 67% (n = 55) of White patients (p= 0.2). Compared to White patients, Black patients were similar in age (59.39 years ± 8.95 vs. 61.59 years ± 11.38, p = 0.4), BMI (31.13kg/m2 ± 3.59 vs. 31.07kg/m2 ± 5.93, p = > 0.9), AHI 4% (34.32 events/hour ± 23.68 vs. 32.83 events/hour ± 19.74, p = 0.8), and neck circumference (40.41cm ± 4.16 vs. 41.22cm ± 4.12, p = 0.5). Chi-squared analysis revealed statistically significant differences in rates of AP collapse between White and Black patients (70% vs 44%, p = 0.047).

Conclusions: This study suggests Black patients are less likely than White to show AP collapse at the velum, causing ineligibility for UAS surgery. Variations in UA anatomy and OSA pathophysiology between racial groups could underlie these disparities. Future research should aim to better understand these differences and develop new therapies to address diverse OSA phenotypes.