A New Technological Advancement of the Drug-Induced Sleep Endoscopy (DISE) Procedure: The “All in One Glance” Strategy

Abstract

To illustrate a new technological advance in the standard drug-induced sleep endoscopy (DISE) model, a new machine was used, the Experimental 5 Video Stream System (5VsEs), which is capable of simultaneously visualizing all the decisional parameters on a single monitor, and recording and storing them in a single uneditable video. The DISE procedure was performed on 48 obstructive sleep apnea (OSA) or snoring patients. The parameters simultaneously recorded on a single monitor are (1) the pharmacokinetics and pharmacodynamics of propofol (through the target controlled infusion (TCI) pump monitor), (2) the endoscopic upper airway view, (3) the polygraphic pattern, and (4) the level of sedation (through the bispectral index (BIS) value). In parallel to the BIS recording, the middle latency auditory evoked potential (MLAEP) was also recorded and provided. Recorded videos from the 5VsEs machine were re-evaluated six months later by the same clinician and a second clinician to evaluate the concordance of the therapeutic indications between the two. After the six-month period, the same operator confirmed all their clinical decisions for 45 out of 48 videos. Three videos were no longer evaluable for technical reasons, so were excluded from further analysis. The comparison between the two operators showed a complete adherence in 98% of cases. The 5VsEs machine provides a multiparametric evaluation setting, defined as an “all in one glance” strategy, which allows a faster and more effective interpretation of all the simultaneous parameters during the DISE procedure, improving the diagnostic accuracy, and providing a more accurate post-analysis, as well as legal and research advantages.

The Use of Middle Latency Auditory Evoked Potentials (MLAEP) as Methodology for Evaluating Sedation Level in Propofol-Drug Induced Sleep Endoscopy (DISE) Procedure

“…Moreover, the MLAEPi’s faster response also seemed to lead to a better alignment to propofol pharmacodynamics. Figure 4 shows the 5VsEs [ 34 ] technology developed for this research area. The predicted effect site propofol concentration was 3.5μg /mL.…”

“…We used the following medical devices: (1) a flexible endoscope (rhinolaryngoscope, 11101 series, Karl Storz ® CDD, Tuttlingen, Germany); (2) a compatible camera (image 1 22201020, Karl Storz ® Tuttlingen, Germany); (3) an American Academy of Sleep Medicine (AASM)-compliant home sleep apnea testing device (Embletta Gold Portable Testing Device ® , RemLogicE ® Software 2015, Embla System Inc., Broomfield, CO, USA) and its nasal canula and thermistors; (4) an oximeter (Nonin XPOD ® , Plymouth, UK) with a finger probe; (5) a BIS system (Covidien Ireland Limited ® , Dublin, Irland); and (6) a TCI (target controlled infusion) pump (Alaris PK ® by Carefusion PK, Basingstoke, UK), plus a middle latency auditory evoked potentials (MLAEPs) system (A-line ® sw version 1.5, owned by Danmeter A/S Denmark, Odense, Danmark). All parameters were shown in a parallel mode using the 5VsEs (5 Video stream Experimental system), that unifies all monitors used in DISE procedure up on a single monitor, already developed for this specific task [ 34 ]. The BIS range is from 100 (wide awake) to 0, with a recommended range from 80 to 60 to successfully perform DISE [ 5 ].…”

“…The BIS, MLAEPi, polygraphy and pharmacodynamic events, as well as endoscopy, were collected through our 5VsEs machine [ 34 ], which is a technological improvement of the standard DISE that permits obtaining useful multiparametric storage for post-analysis and research. All these parameters were simultaneously shown on a 5VsEs single monitor (5VsEs patent no.…”

A review of the “OMICS” for management of patients with obstructive sleep apnoea

“…In the literature, proteomics and metabolomics approaches were used to detect change in physiological or pathological status of OSA patients compared to controls, in order to discover new mediators that can be used as biomarkers of the disease. Notwithstanding, OSA and therapies related to this disease 71-73 , are a somewhat ‘new’, and there are many proteins and metabolites that are associated with the disease, in particular those involved in inflammation and oxidative stress, in line with the clinical IH that patients undergo in OSA.…”

Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment

“…It consists in an upper airway evaluation during a pharmacologically simulated sleep. Yu Lin et al [ 15 ] and other literature evidence [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] has stated that DISE is superior to the wake-up endoscopy in identifying obstructions sites and types of collapses in the hypopharyngeal and base of the tongue regions. Recently, the use of a middle latency auditory evoked potentials (MLAEP) has been proposed as a good methodology to evaluate the correct level of sedation for patients during DISE procedures [ 16 , 17 ].…”