Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system

Yeğin, Yakup; Çelik, Mustafa; Kaya, Kamïl Hakan; Koç, Arzu Karaman; Kayhan, Fatma Tülin

doi:10.1016/j.bjorl.2016.05.009

Cited by 37 publications

(24 citation statements)

References 24 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%

“…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. 8,33 With the introduction of DISE, the lateral pharyngeal wall and epiglottis have emerged as possible sites of obstruction in OSA. Lateral pharyngeal wall and epiglottis obstructions may have been previously underrecognized as factors in OSA.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

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 DISE can be used for planning other treatments that might be offered to CPAP-intolerant patients 41 . The VOTE system then provides a standardized qualitative framework to describe DISE results, in a setting without proprioceptive feedback; in contrast the Müller maneuver is focused on the oropharynx 42 .…”

Section: The Vote Classificationmentioning

confidence: 99%

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Strohl

Yamauchi

Peng

2017

Curr Sleep Medicine Rep

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Purpose The literature on hypoglossal nerve stimulation (HNS) for the treatment of moderate-to-severe obstructive sleep apnea (OSA) was reviewed from 2014, the time of FDA approval for the Inspire Systems device, to 2017 for themes that might be useful conceptually and practically in the consideration of this new non-anatomic surgical therapy. Recent Findings there are now further follow-up articles since the 12-month results for Apnea Reduction (STAR) trial of the Inspire device, and post-approval publications which report similar and/0r improved AHI outcomes. Other emerging themes include drug-induced sedation endoscopy (DISE) as a tool in assessment of eligibility and a more detailed understanding of mechanisms for an HNS effects. Summary The post-STAR literature provides guidelines for an integrated coordination of medicine and surgery to appropriately screen and manage patients.

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“…It is characterized by episodes of apnea and hypopnea as a result of upper airway obstruction [2] and can be associated with multiple comorbidities and adverse cardiovascular events [3]. Drug-induced sleep endoscopy (DISE) was proposed by Croft and Pringle in 1991 [4] and is considered an important tool for evaluation of the degree and sites of upper airway obstruction in patients with obstructive sleep apnea [5,6].…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine added to propofol for drug-induced sleep endoscopy in adult patients with obstructive sleep apnea: Randomized controlled trial

Abdelgalel

2018

Egyptian Journal of Anaesthesia

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Background: The aim of this study was to evaluate if the addition of dexmedetomidine to propofol could improve the success and reduce the complications during drug induced sleep endoscopy in obstructive sleep apnea patients. Patient and methods: Fifty adult patients scheduled for drug induced sleep endoscopy were randomly allocated to one of two groups. Group P (25 patients) received propofol loading dose of 0.5 mg/kg over 3 min then continuous infusion in a dose of 25-75 mcg/kg/min. Group PD (25 patients) received propofol infusion as group P and dexmedetomidine intravenous infusion with a loading dose of 0.5 mcg/kg over 5 min then continuous infusion in a dose of 0.2-0.7 mcg/kg/h. The primary outcome was successful completion of the procedure. The secondary outcomes included the time to start endoscopy, procedure duration, the incidence of adverse events and surgeons and patients satisfaction. Results: Successful completion of the procedure was significantly higher in group PD (96%) compared to group P (72%). The total propofol dose needed/patient (mg) was significantly more in group P compared to group PD (173.5 ± 41.6 versus98.4 ± 19.8 with shorter recovery time in group PD. Both surgeons and patients satisfaction were significantly higher in group PD compared to group P. The incidence of cough and gag reflexes were significantly higher in group P compared to group PD. Heart rate (HR) was significantly lower in group PD compared to group P at 5, 10, 15, 20, 25 and 30 min from the start of the studied drugs. Respiratory rate (RR) was significantly lower in group P compared to group PD at 5, 10, 15 and 20 min from the start of the studied drugs (p < 0.05). Conclusion: Addition of dexmedetomidine to propofol is associated with higher incidence of successful completion of the procedure with faster recovery. Cough and gag reflexes were significantly lower with the addition of dexmedetomidine with higher surgeons and patients satisfaction.

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Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system

Cited by 37 publications

References 24 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

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Dexmedetomidine added to propofol for drug-induced sleep endoscopy in adult patients with obstructive sleep apnea: Randomized controlled trial

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