A Critical Analysis of Pharyngeal Patterns of Collapse in Obstructive Sleep Apnea: Beyond the Endoscopic Classification Systems

Abstract

(1) Background: Drug-Induced Sleep Endoscopy (DISE) enables the three-dimensional and dynamic visualization of the upper airway (UA) during sleep, which is useful in selecting the best treatment option for obstructive sleep apnea (OSA) patients, particularly for surgical procedures. Despite international consensus statements or position papers, a universally accepted DISE methodology and classification system remain a controversial open question. (2) Methods: A review of the English scientific literature on DISE related to endoscopic classification systems and surgical outcome predictors (3) Results: Of the 105 articles, 47 were included in the analysis based on their content’s relevance to the searched keywords. (4) Conclusions: A final report and scoring classification system is not universally accepted; the most internationally applied endoscopic classification system during DISE does not cover all patterns of events that occur simultaneously during the endoscopic examination, highlighting that several configurations of collapse and obstruction at different UA levels could be observed during DISE, which should be described in detail if DISE has to be considered in the decision-making process for the UA surgical treatment in OSA patients and if DISE has to have a role as a predictive factor for surgical outcomes analysis.

The Resolution of Obstructive Sleep Apnea in a Patient with Goiter after Total Thyroidectomy: A Case Report

“…Drug-induced sleep endoscopy (DISE) allows for the three-dimensional and dynamic visualization of the upper airway during sleep. It represents one of the widespread diagnostic procedures for identifying the anatomical sites of upper airway obstruction in OSA patients, classifying the findings according to the severity and configuration of UA collapse [20,21]. DISE may also play a pivotal role in selecting and customizing candidates for upper airway surgical treatment, as well as mandibular advancement devices (MADs), hypoglossal nerve stimulation and analyzing CPAP failure [20].…”

“…It represents one of the widespread diagnostic procedures for identifying the anatomical sites of upper airway obstruction in OSA patients, classifying the findings according to the severity and configuration of UA collapse [20,21]. DISE may also play a pivotal role in selecting and customizing candidates for upper airway surgical treatment, as well as mandibular advancement devices (MADs), hypoglossal nerve stimulation and analyzing CPAP failure [20]. In this case, if DISE had been performed, it might have been possible to describe the consequences of goiter on upper airway collapsibility during sleep and to determine the potential implication of other contributing factors for OSA.…”

“…In this case, if DISE had been performed, it might have been possible to describe the consequences of goiter on upper airway collapsibility during sleep and to determine the potential implication of other contributing factors for OSA. Indeed, observing dynamics such as the severity of obstruction and patterns of collapse at multiple levels appears to be significant for understanding the underlying causal mechanisms of upper airway obstruction [20].…”

Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 2 Decision-Making in Surgical Management and Peri-Operative Considerations

“…It considers many factors, such as patient age, comorbidities, stage, severity of the disease, pheno-and endotypes of OSA, phenotypes of the palate, and anatomic features of the upper airway [10,11]. Results from additional diagnostic procedures, such as drug-induced sleep endoscopy, craniofacial computed tomography, and dynamic sleep magnetic resonance, are also considered [12,13].…”