Clinical analysis of drug‐induced sleep endoscopy for the <scp>OSA</scp> patient

Golbin, Dina; Musgrave, Brandon; Succar, Eric; Yaremchuk, Kathleen

doi:10.1002/lary.25516

Cited by 28 publications

(27 citation statements)

References 23 publications

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“…46,47 Moreover, age was included in the logistic regression model to control for its influence. (ii) As a UA collapsibility evaluation method, DISE itself has some limitations, such as controversy about the reliability of observed obstructive sites, 48 that it might not improve surgical success rates, 49 and variable findings with prolonged observation time or different sedative drugs. 44,50 Dexmedetomidine was used for sedation, and differences in tongue base collapse related to propofol or midazolam use have already been identified.…”

Section: Discussionmentioning

confidence: 99%

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Zhao

Viana

et al. 2020

NSS

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Identification of upper airway (UA) obstruction based on pharyngeal factors is important for obstructive sleep apnea (OSA) evaluation. This study is to assess the association between UA collapse characteristics and Friedman tongue position (FTP) in patients with OSA through drug-induced sleep endoscopy (DISE). Patients and Methods: Retrospective study in individuals with OSA who were intolerant to continuous positive airway pressure (CPAP) treatment, submitted to DISE between June 1, 2013, and July 31, 2017. All subjects were classified as having an FTP grade of I to IV, and the velum, oropharynx, tongue base, epiglottis (VOTE) classification was used to analyze the DISE findings. UA collapse characteristics by DISE and FTP grading were compared between groups. The associations between specific DISE findings and FTP were analyzed. Results: In total, 205 patients were assessed. A positive and significant correlation was identified between the presence of retropalatal complete concentric collapse (CCC) and FTP grade, according to the following distributions: I, 17.4%; II, 22.9%; III, 33.7%; and IV, 48.7% (P = 0.014). A logistic regression model revealed that CCC was associated with FTP grade IV. After adjusting for age, sex, body mass index (BMI), and tonsil size (TS), the grade IV individuals had a 4.4-fold higher risk of having CCC than grade I individuals (P = 0.026). Multiple collapse sites and palatopharyngeal or combined (palatopharyngeal and hypopharyngeal) collapse were more prevalent in grade IV individuals. Conclusion: OSA patients intolerant to CPAP have a strong positive correlation between the FTP grade and presence of retropalatal CCC. FTP grade IV is an independent risk factor for velum-CCC, controlling for sex, age, BMI, and TS grade.

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Section: Discussionmentioning

confidence: 99%

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Zhao

Viana

et al. 2020

NSS

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“…The author concluded that D.I.S.E. does not improve the surgical success rate of surgery, but when more surgery is indicated, the rate of complications also increase [5].…”

Section: Resultsmentioning

confidence: 99%

Drug-Induced Sleep Endoscopy with Target-Controlled Infusion Using Propofol in the Management of Patients with Obstructive Sleep Apnea

Stefanescu¹,

Hainăroşie²,

Zainea³

2018

Rev. Chim.

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Although it seems to be an exhausted subject at first glance, the therapeutic approach in obstructive sleep apnea syndrome (O.S.A.S.) is still an open subject. The continuous positive airway pressure (C.P.A.P.) represents the gold standard of therapy in O.S.A.S. However, this therapeutic process with C.P.A.P. has a low rate of compliancy, over 50% of patients quit in the first year of use. Implicitly, surgical solutions or mandibular advancement devices remain an alternative for many of these patients. High costs, complexity and risks associated with surgery have led to the identification of more accurate methods for topographic and functional diagnosis in O.S.A.S. Drug-induced sleep endoscopy (D.I.S.E.) with target-controlled infusion (T.C.I.) using propofol in the management of patients with obstructive sleep apnea is a relatively recently introduced method in Romania. The present paper describes our experience with D.I.S.E for selected patients, who have undergone surgery on the upper airway for O.S.A.S. The D.I.S.E method has led to the modification of the initial surgical plan in over 60% of patients with multi-level obstruction. Under these conditions, the surgical success rate in patients of the study increased to 80% at 6 months. Considering the specific endowment of each tertiary sleep center, the presence or absence of an operator block and the anesthetist�s experience with target-controlled (T.C.I.) infusion using propofol, more extensive and multicenter studies are needed for standardization of D.I.S.E.

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“…Finally, cine MRI and DISE both have been developed as dynamic airway evaluative tools and have overcome the limitation of the baseline muscle tone in the awake state that prevents visualization of upper airway collapse. However, both methods are significantly costly from a healthcare utilization standpoint due to their reliance on anesthesia and operating room resources …”

Section: Discussionmentioning

confidence: 99%

“…However, both methods are significantly costly from a healthcare utilization standpoint due to their reliance on anesthesia and operating room resources. 28,29 Computer simulation and upper airway modeling has been proposed as a method to overcome inherent limitations of clinical examination techniques in assessing patient sites of anatomic collapse. Further, this method is more cost-effective as a means of airway evaluation by avoiding anesthetic administration, and it offers the potential for subsite manipulation using computer software to determine an optimal airway configuration.…”

Section: Discussionmentioning

confidence: 99%

Constructing a patient‐specific computer model of the upper airway in sleep apnea patients

et al. 2017

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Objective: The use of computer simulation to develop a high-fidelity model has been proposed as a novel and costeffective alternative to help guide therapeutic intervention in sleep apnea surgery. We describe a computer model based on patient-specific anatomy of obstructive sleep apnea (OSA) subjects wherein the percentage and sites of upper airway collapse are compared to findings on drug-induced sleep endoscopy (DISE).Study Design: Basic science computer model generation.Methods: Three-dimensional finite element techniques were undertaken for model development in a pilot study of four OSA patients. Magnetic resonance imaging was used to capture patient anatomy and software employed to outline critical anatomical structures. A finite-element mesh was applied to the volume enclosed by each structure. Linear and hyperelastic soft-tissue properties for various subsites (tonsils, uvula, soft palate, and tongue base) were derived using an inverse finiteelement technique from surgical specimens. Each model underwent computer simulation to determine the degree of displacement on various structures within the upper airway, and these findings were compared to DISE exams performed on the four study patients.Results: Computer simulation predictions for percentage of airway collapse and site of maximal collapse show agreement with observed results seen on endoscopic visualization.Conclusion: Modeling the upper airway in OSA patients is feasible and holds promise in aiding patient-specific surgical treatment.

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Clinical analysis of drug‐induced sleep endoscopy for the OSA patient

Cited by 28 publications

References 23 publications

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Drug-Induced Sleep Endoscopy with Target-Controlled Infusion Using Propofol in the Management of Patients with Obstructive Sleep Apnea

Constructing a patient‐specific computer model of the upper airway in sleep apnea patients

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