A comparison of the Fujita classification of awake and drug-induced sleep endoscopy patients

Rabelo, Fábio Augusto Winckler; Küpper, Daniel; Sander, Heidi H.; Júnior, Vanier dos Santos; Thuler, Eric; Fernandes, Regina Maria França; Valera, Fabiana Cardoso Pereira

doi:10.5935/1808-8694.20130017

Cited by 29 publications

(30 citation statements)

References 15 publications

(19 reference statements)

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“…Obstructions at a single level were observed in 47.83%, while multilevel obstructions were observed in 52.17%. 15 However, other studies evaluating the airway during wakefulness and under induced sleep did not differ significantly in the presence of severe retropalatal collapse, but showed significant difference in the incidence of severe retrolingual collapse. Gregorio et al, when analyzing a small sample of eight patients, using midazolam to perform sedation, observed similar retropalatal obstruction during the Müller maneuver (MM) and induced sleep.…”

Section: Resultsmentioning

confidence: 96%

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

Viana

Thuler

Araújo-Melo

2015

Brazilian Journal of Otorhinolaryngology

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Section: Resultsmentioning

confidence: 96%

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

Viana

Thuler

Araújo-Melo

2015

Brazilian Journal of Otorhinolaryngology

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“…15 Recently, Hong et al 16 also revealed that different BIS levels had different degrees of upper airway narrowing by repeated DISE in the same patient but different BIS level.…”

Section: Bispectral Index In Evaluating Effects Of Sedation Depth On mentioning

confidence: 99%

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

Wang

et al. 2015

Journal of Clinical Sleep Medicine

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achieve a target effect site (brain) concentration of propofol. However, patients may lose consciousness at variable effect site concentrations (Ce), with a higher Ce being associated with higher upper airway critical closing pressure.6,7 Most DISE procedures are started shortly after the patients lose consciousness. Objective:To evaluate the effect of sedation depth on druginduced sleep endoscopy (DISE). Methods: Ninety patients with obstructive sleep apnea (OSA) and 18 snorers underwent polysomnography and DISE under bispectral index (BIS)-guided propofol infusion at two different sedation levels: BIS 65-75 (light sedation) and 50-60 (deep sedation). Results: For the patients with OSA, the percentages of velopharynx, oropharynx, hypopharynx, and larynx obstructions under light sedation were 77.8%, 63.3%, 30%, and 33.3%, respectively. Sedation depth was associated with the severity of velopharynx and oropharynx obstruction, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse. In comparison, OSA severity was associated with the severity of velopharynx obstruction, severity of oropharynx obstruction, and arytenoid prolapse (odds ratio (95% confi dence interval); 14.3 (4.7-43.4), 11.7 (4.2-32.9), and 13.2 (2.8-62.3), respectively). A good agreement was noted between similar DISE fi ndings at different times and different observers (kappa value 0.6 to 1, respectively 1 Drug-induced sleep endoscopy (DISE) has been used for decades to directly examine the upper airways in sedative-induced sleep and improve treatment outcomes by acting as an adjuvant tool to assess surgical or nonsurgical treatment options. 2-4Various sedation methods have been used to allow for the performance of DISE. Roblin introduced target-controlled infusion (TCI) of propofol to DISE to allow for better control of the sedation level.5 TCI of propofol uses computer-based pharmacokinetic and pharmacodynamic models to predict and Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep EndoscopyYu-Lun Lo, MD BRIEF SUMMARYCurrent Knowledge/Study Rationale: Drug-induced sleep endoscopy (DISE) were performed under different sedative conditions and might affect upper airway obstructions. We aimed to evaluate the affects of sedation depth and obstructive sleep apnea severity on different upper airway obstruction patterns. Study Impact: Under DISE, sedation depth affected velopharynx and oropharynx obstruction severity, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse; however, OSA severity was associated with velopharynx and oropharynx obstruction severity as well as arytenoid prolapse. Bispectral index guided DISE offers an objective and reproducible method to evaluate upper airway collapsibility.

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“…In addition, attention to the variety of sedation methods that can be used is needed. Unlike our study, propofol was often used in previous studies conducted in Western countries [9,11,15]. Because of the limited analgesic effect, the use of propofol as a single agent for GI endoscopy tends to be required in higher sedation levels [28].…”

Section: Discussionmentioning

confidence: 89%

“…After the subjects were placed in a left lateral position with their jaws thrusted forward, a flexible endoscope (GIF-H260Z; Olympus Optical, Tokyo, Japan) was introduced perorally. The obstruction sites were then classified into 3 different subtypes based on the modified Fujita Classification: oropharyngeal, supraglottic, and combined type [15]. In addition, the level of obstruction (non-significant obstruction: 0-25%, mild: 25-50%, moderate: 50-75%, severe: > 75%) and the dynamic pattern of collapse (antero-posterior, latero-lateral, and circumferential) were also evaluated.…”

Section: Gi Endoscopic Examinationmentioning

confidence: 99%

Efficacy of Upper Gastrointestinal Endoscopic Examination to Identify Patients with Obstructive Sleep Apnea Syndrome: A Retrospective Cross-Sectional Study

et al. 2018

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Background/Aims: Despite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS. Methods: After endoscopic evaluation of laryngo-pharyngeal collapse, a total of 154 subjects with laryngo-pharyngeal collapse and 52 control subjects underwent polysomnography. Based on the modified Fujita Classification, upper airway obstruction was classified into 3 different types: oropharyngeal, supraglottic and combined type, and associations between upper airway obstruction and OSAS were evaluated. Results: Of 154 subjects with laryngo-pharyngeal collapse, 108 (70.1%) were diagnosed as OSAS, while only 4 (7.7%) control subjects were diagnosed as OSAS (p < 0.001). The sensitivity and specificity of endoscopic diagnosis were 96.4 and 51.1%, respectively. Oropharyngeal involvement was frequently found in 90.2% of the subjects (139/154). The severity of upper airway obstruction was significantly correlated with the apnea-hypopnea index score (r = 0.55, p < 0.001). A multivariate logistic regression analysis revealed that a male sex (OR 5.20; 95% CI 2.65–10.2, p < 0.001), body mass index ≥25 kg/m² (OR 4.98; 95% CI 2.23–11.2, p = 0.02) and severe obstruction (OR 7.79; 95% CI 3.34–18.2, p < 0.001) were significant independent predictors of severe OSAS. Conclusion: A conventional upper GI endoscopic examination might be useful as a diagnostic modality for OSAS.

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A comparison of the Fujita classification of awake and drug-induced sleep endoscopy patients

Abstract: There was no agreement between the endoscopic findings of endoscopic examinations done with the patient awake or in drug-induced sleep.

Cited by 29 publications

References 15 publications

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

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

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

Efficacy of Upper Gastrointestinal Endoscopic Examination to Identify Patients with Obstructive Sleep Apnea Syndrome: A Retrospective Cross-Sectional Study

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