Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete collapse of the pharynx that result in a decrease in oxyhemoglobin saturation. Nasofibrolaryngoscopy under induced sleep is a promising alternative for identifying sites of upper airway obstruction in patients with OSA. This study aimed to compare the obstruction sites screened by drug-induced sleep endoscopy (DISE) using the Nose oropharynx hypopharynx and larynx (NOHL) and Velum oropharynx tongue base epiglottis (VOTE) classifications. We also determined the relationship between OSA severity and the number of obstruction sites and compared the minimum SaO levels between DISE and polysomnography (PSG). This was a prospective study in 45 patients with moderate and severe OSA using DISE with target-controlled infusion of propofol bispectral index (BIS) monitoring. The retropalatal region was the most frequent obstruction site, followed by the retrolingual region. Forty-two percent of patients had obstruction in the epiglottis. Concentrically shaped obstructions were more prevalent in both ratings. The relationship between OSA severity and number of obstruction sites was significant for the VOTE classification. Similar minimum SaO values were observed in DISE and PSG. The VOTE classification was more comprehensive in the analysis of the epiglottis and pharynx by DISE and the relationship between OSA severity and number of affected sites was also established by VOTE. The use of BIS associated with DISE is a reliable tool for the assessment of OSA patients.

Sleep breathing disorders are estimated to be present in 2%–4% of middle-aged adults. Serious adverse consequences, such as systemic arterial hypertension, myocardial infraction, and cerebrovascular disease, can be related to these conditions. Intellectual deficits associated with attention, memory, and problem-solving have also been associated with a poor quality of sleep. The main causes of these disorders are obstructions resulting from repetitive narrowing and closure of the pharyngeal airway, which have been monitored by indirect measurements of temperature, displacement, and other highly invasive procedures. The measurement of mechanical impedance of the respiratory system by the forced oscillation technique (FOT) has recently been suggested to quantify the respiratory obstruction during sleep. It is claimed that the noninvasive and dynamic characteristics of this technique would allow a noninvasive and accurate analysis of these events. In spite of this high scientific and clinical potential, there is no detailed description of a complete instrumentation system to implement this promising technique in sleep studies. In this context, the purpose of this study was twofold: (1) describe the development of a new computer-based system for identification of the mechanical impedance of the respiratory system during sleep by the FOT and (2) evaluate the performance of this device in the description of respiratory events in conditions including no, mild, serious disease, and therapeutic procedures. These evaluations confirmed the desirable features achieved in laboratory tests and the high scientific and clinical potential of this system.

In most trials, nasal obstruction was not related to the apnea-hypopnea index (AHI), indicating no improvement in OSAS with reduction in nasal resistance. However, few researchers evaluated other polysomnography indices, such as the arousal index and rapid eye movement (REM) sleep percentage. These could change with nasal obstruction, since it is possible that the nasal obstruction does not completely block the upper airways, but can increase negative intrathoracic pressure, leading to sleep fragmentation.

Original Article Original Article Original Article Original Article Original Article DOI: 10.1590/0100-69912015005004 Correlation between the oropharyngo-laryngoscopic findings and Correlation between the oropharyngo-laryngoscopic findings and Correlation between the oropharyngo-laryngoscopic findings and Correlation between the oropharyngo-laryngoscopic findings and Correlation between the oropharyngo-laryngoscopic findings and the severity of obstructive sleep apnea the severity of obstructive sleep apnea the severity of obstructive sleep apnea the severity of obstructive sleep apnea the severity of obstructive sleep apnea Correlação entre os achados orofaringolaringoscópicos e a gravidade da Correlação entre os achados orofaringolaringoscópicos e a gravidade da Correlação entre os achados orofaringolaringoscópicos e a gravidade da Correlação entre os achados orofaringolaringoscópicos e a gravidade da Correlação entre os achados orofaringolaringoscópicos e a gravidade da síndrome da apneia obstrutiva do sono síndrome da apneia obstrutiva do sono síndrome da apneia obstrutiva do sono síndrome da apneia obstrutiva do sono síndrome da apneia obstrutiva do sono We conducted a cross-sectional study of 66 patients of both genders, aged between 21 and 59 years old with complaints of snoring and / or apnea. All underwent full clinical evaluation, including physical examination, nasolarybgoscopy and polisonography. We classified individuals into groups by the value of the apnea-hypopnea index (AHI), calculated measures of association and analyzed differences by the Kruskal-Wallis and chi-square tests. Results Results ResultsResults Results: all patients with obesity type 2 had OSAS. We found a relationship between the uvula projection during nasoendoscopy and OSAS (OR: 4.9; p-value: 0.008; CI: 1.25-22.9). In addition, there was a major strength of association between the circular shape of the pharynx and the presence of moderate or severe OSAS (OR: 9.4, p-value: 0.002), although the CI was wide (1.80-53.13). The septal deviation and lower turbinate hypertrophy were the most frequent nasal alterations, however unrelated to gravity. Nasal obstruction was four times more common in patients without daytime sleepiness. The other craniofacial anatomical changes were not predictors for the occurrence of OSAS. Conclusion Conclusion Conclusion Conclusion Conclusion: oral, pharyngeal and laryngeal disorders participate in the pathophysiology of OSAS. The completion of the endoscopic examination is of great value to the evaluation of these patients. The pathophysiology of OSAS is multifactorial, however evidence shows that UA muscle control is the result of a delicate balance between different forces of intraluminal pressure during inspiration, which leads to a negative transpharyngeal pressure gradient, and the extraluminal pressure forces derived from muscle contractions that contribute to opening of the pharynx. Factors such as vasomotor tone and mucosal adhesive forces seem to collaborate with UA narrowing or collapse 3 . ...

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