Comparison of Findings between Clinical Examinations and Drug-Induced Sleep Endoscopy in Patients with Obstructive Sleep Apnea Syndrome

Abstract

The Velum, Oropharynx, Tongue base and Epiglottis (VOTE) classification on drug-induced sleep endoscopy (DISE) is used widely for obstructive sleep apnea (OSA) syndrome, though research into comparative physical examinations with VOTE on DISE is still limited. The aim of this study was to evaluate the relationship between the findings of physical examinations and DISE in patients with OSA. Fifty-five patients with OSA were enrolled in this retrospective study. All of the patients received clinical explorations including a Brodsky classification, a modified Mallampati score (MMS), a modified Friedman’s staging system, and a Muller’s test. Drug-induced sleep endoscopy was further evaluated in the operating room. There were significant relationships between Brodsky classification, modified Friedman’s staging system, Muller’s test and oropharynx collapse during DISE (p < 0.05). Brodsky classification, MMS, modified Friedman’s staging system and retropalatal lateral-to-lateral (L–L) collapse of Muller’s test were significantly correlated with VOTE count (p < 0.05). The concordance between VOTE under DISE and Brodsky classification or modified Friedman’s staging system was moderate. In contrast, the concordance between VOTE under DISE and MMS or Muller’s test was slight. The study revealed that Brodsky classification and Friedman staging had a significant relationship with DISE on the velum and oropharynx, but the level of tongue base is uncertain between DISE and MMS. Correlation of awake evaluation of tongue base is still not correlated to the DISE findings. Pre-treatment evaluation of DISE is still warranted.

Post-Operative Sleep Endoscopy with Target-Controlled Infusion After Palatopharyngoplasty for Obstructive Sleep Apnea: Anatomical and Polysomnographic Outcomes

“…21 In addition, multilevel upper airway obstruction occurs in many patients with OSA, 22 but the assessment in awake state does not predict tongue base collapse in sleep. 23 Thus, DISE could potentially be used to guide surgical decision-making.…”

Novel Intraoral Negative Airway Pressure in Drug-Induced Sleep Endoscopy with Target-Controlled Infusion

“… 22 This procedure produces a dynamic image in real time, thus enabling the observation of the sites of upper airway obstruction in simulated sleep that is typically not possible during awake endoscopy, especially with regard to tongue base obstruction. 23 Thus, DISE can potentially be used to identify responders and nonresponders to OPT treatment. Furthermore, DISE can help understand the pathophysiology of specific collapse patterns and determine the optimal treatment option accordingly.…”

Impact of Upper Airway Characteristics on Disease Severity and CPAP Therapy in Chinese Patients With OSA: An Observational Retrospective Study

“…The main disadvantage of awake endoscopy is that the physiology is inconsistent with sleep when OSA occurs. Some previous studies compared waking laryngoscope to druginduced endoscopy (40,44,45). Still, the velum and oropharynx positions showed good correlations between the waking state and drug-induced sleep.…”