Background: Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with obstructive sleep apnea (OSA). To this end, several diagnostic tests and procedures have been developed. These include endoscopic and imaging modalities. However, the latter is not practical as it has issues of logistics and feasibility. The former includes routine awake flexiblescopy (FS) in outpatient department and drug-induced sleep endoscopy (DISE). This study intends to compare the incidence of epiglottic fall, which is the most common laryngeal cause of OSA, in routine awake FS vs DISE. Materials and methods: Thirty patients with OSA were prospectively enrolled in this sectional analytic study. All underwent proper history taking, ENT evaluation including awake FS with Muller\'s maneuver, polysomnography, and DISE. The upper airway collapse was documented as per velum oropharynx tongue base epiglottis (VOTE) classification. Results: The incidence of epiglottic collapse seen in FS was 6.7% (2 patients) and in DISE was 40% (12 patients), which was statistically significant (p 0.002). Conclusion: Drug-induced sleep endoscopy is a more accurate diagnostic option for detecting the level of obstruction and degree of collapse, especially laryngeal collapse in OSA than FS.
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