Drug-induced sleep endoscopy in the identification of obstruction sites in patients with obstructive sleep apnea: a systematic review

Viana, Alonço; Thuler, Luiz Cláudio Santos; Araújo-Melo, Maria Helena de

doi:10.1016/j.bjorl.2015.01.007

Cited by 37 publications

(39 citation statements)

References 17 publications

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“…Although there are limitations related to classification, we ultimately determined that the rate of obstruction was approximately 85% to 90% for the soft palate, 30% for the tonsil (or lateral pharyngeal wall), 50% to 60% for the tongue base, and 30% for the epiglottis in OSA patients. Consistent with the present results, most studies agree that the soft palate is the most common site of obstruction and that the tongue base is also blocked in half of the patients . With the introduction of DISE, the lateral pharyngeal wall and epiglottis have emerged as possible sites of obstruction in OSA.…”

Section: Discussionsupporting

confidence: 91%

“…A total of 2,078 patients from 13 studies were included in the meta‐regression of tongue base obstruction rate moderated by mean AHI . Figure shows that tongue obstruction rate tended to increase with higher mean AHI value (slope: 0.056, P value < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Based on the data to date, a consensus exists regarding the following statements: 1) observations during the awakened state do not accurately reflect the occlusion site during sleep; 2) it is more effective to confirm the obstruction site by observing the movement of the upper airway rather than observing the static situation at a certain moment in time; and 3) three‐dimensional (3D) stereoscopic images, rather than 2D cross‐sectional images, more effectively visualize the obstruction site. Thus, the most suitable and widely used diagnostic tool is currently drug‐induced sleep endoscopy (DISE), which involves placing a flexible endoscope through the nose and observing the entire upper airway after anesthetizing the patient with a sedative . However, the published results on the obstruction sites identified using DISE have been quite diverse across studies, and no study has analyzed the combined results.…”

Section: Introductionmentioning

confidence: 99%

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Meta‐Analysis of Obstruction Site Observed With Drug‐Induced Sleep Endoscopy in Patients With Obstructive Sleep Apnea

Lee

Cho

2018

The Laryngoscope

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Objective To perform a meta‐analysis on the distribution and characteristics of the obstructive site in patients with obstructive sleep apnea (OSA) using data from a variety of published studies that evaluated the obstruction with drug‐induced sleep endoscopy (DISE). Methods A literature search was performed to identify studies in which DISE was used to identify the obstruction site in adult patients with OSA, and the obstruction site was described in sufficient detail. Four items were evaluated in the meta‐analysis: the obstruction site, closing direction of the soft palate, degree of closure, and percentage of single‐level obstructions. Results A total of 2,950 patients from 19 studies were included. In the two‐level classification system, the rate of obstruction was 91.6% for the soft palate and 58.0% for the tongue base. In the four‐level classification system, the rate of obstruction was 84.1% for soft palate, 32.8% for the tonsil, 51.6% for the tongue base, and 34.3% for the epiglottis. The soft palate closed in the anteroposterior direction at a rate of 44.4% and in the concentric direction at a rate of 46.5%. The rate of a closure of 75% or more was 69.3% for the soft palate and 56.8% for the hypopharynx. The percentage of single‐level obstructions was 42.5%. Conclusion The soft palate is obstructed in most patients with OSA, and the tongue base is obstructed in half of the patients. In addition, multilevel obstructions including the tonsil, lateral pharyngeal wall, or epiglottis are common; thus, these areas must be checked carefully. Level of Evidence NA Laryngoscope, 129:1235–1243, 2019

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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Meta‐Analysis of Obstruction Site Observed With Drug‐Induced Sleep Endoscopy in Patients With Obstructive Sleep Apnea

Lee

Cho

2018

The Laryngoscope

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“…The incidence of OSA in children is reported lower than adult. 1 Obstructive sleep apnea syndrome (OSAS) may inspire poor concentration, excessive daytime somnolence, morning headaches, metabolic, cardiopulmonary and cardiovascular diseases, and a lower quality of life (QoL). 2 Polysomnography is utilized to diagnose and evaluate the severity of OSAS, and it is accepted as the gold standard diagnostic method for OSAS.…”

Section: Introductionmentioning

confidence: 99%

“…The most common cause of OSAS in children is adenotonsillar hypertrophy. 1,2 Mean platelet volume (MPV) is used as a parameter of platelet functions. Larger platelets are more reactive than platelets of normal platelets.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Adenotonsillectomy on Mean Platelet Volume and Neutrophil-toLymphocyte Ratio

Yeğin¹,

Çelik²,

Olgun³

et al. 2016

Otolaryngol Open J

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Objectives:To explore the effect of adenotonsillectomy on mean platelet volume (MPV) levels and neutrophil to lymphocyte ratio (NLR) values in children with obstructive sleep apnea syndrome (OSAS). Subjects and Methods: In total, 127 children (69 males, 58 females; average age 10.20±8.96 years; range, 5-18 years) who underwent adenotonsillectomy with a diagnosis of OSAS were included in the study. Pre-operative MPV levels and NLR values were compared with measurements in the post-operative third month. A p-value <0.05 was considered to reflect statistical significance. Results: Mean pre-operative MPV values were 8.12±1.28 femtoliters (fL) and mean post-operative MPV values were 7.96±1.01 fL, respectively. Post-operative MPV values were significantly lower than pre-operative measurements (p=0,028, p<0.05). Mean pre-operative NLR levels were 1.46±0.82 and post-operative NLR values were 1.42±1.01, respectively. Post-operative NLR values were significantly lower than pre-operative NLR values (p=0.032, p<0.05). Conclusion: We observed statistically significant lower MPV levels and NLR values after adenotonsillectomy in children with OSAS. Future randomized studies should explore the relationship between the MPV levels, NLR values and parameters in polysomnography in larger numbers of patients with OSAS.

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Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea

Kang

Koltai

Lee

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Drug-induced sleep endoscopy in the identification of obstruction sites in patients with obstructive sleep apnea: a systematic review

Abstract: DISE is an additional method to reveal obstruction sites that have not been detected in awake patients.

Cited by 37 publications

References 17 publications

Meta‐Analysis of Obstruction Site Observed With Drug‐Induced Sleep Endoscopy in Patients With Obstructive Sleep Apnea

Meta‐Analysis of Obstruction Site Observed With Drug‐Induced Sleep Endoscopy in Patients With Obstructive Sleep Apnea

The Effect of Adenotonsillectomy on Mean Platelet Volume and Neutrophil-toLymphocyte Ratio

Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea

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