Drug-induced sleep endoscopy and simulated snoring in patients with sleep-disordered breathing: agreement of anatomic changes in the upper airway

Abstract

Drug-induced sleep endoscopy (DISE) and simulated snoring (SimS) are performed as part of the diagnostic procedure in patients with suspected sleep-disordered breathing (SDB). Despite both techniques frequently performed, they have rarely been evaluated yet in terms of agreement of the obtained results. Both diagnostic procedures were performed consecutively in 40 patients with SDB and documented identically. The obtained data were analysed with respect to the agreement of both procedure at different levels of the oropharynx as well as different patterns of obstruction and vibration. The anterior-posterior collapsibility of the soft palate/uvula revealed a moderate agreement between SimS and DISE (κ = 0.42; 95 % CI 0.22-0.63). The dorsal shift of the tongue base agreed moderate for patients with an AHI below 10 (κ = 0.47) and above 25 (κ = 0.44) between SimS ad DISE. The lateral and circular pharyngeal collapsibility at velum and tongue base level did not agree between SimS and DISE, was higher for DISE and could be partially reversed by mandibular protrusion. Collapse patterns of the soft palate and uvula can be induced by SimS and resemble the patterns induced by DISE. The dorsalization of the tongue base can be simulated to a lower extent by SimS. Lateral and circular patterns of collapse at the upper and lower oropharynx induced by DISE do not seem to be simulated by SimS. SimS seems to be an additional method to screen the collapsibility of the soft palate and uvula prior to DISE.

Awake examination versus DISE for surgical decision making in patients with OSA: A systematic review

“…). The remaining 30 articles were retrieved for more detailed full‐article evaluation, and 23 were excluded because of the lack of a direct comparison between awake examination and DISE, or because of the lack of mention to the impact on surgical decision making . One study was included after a manual search of references of the included studies.…”

LwPTL: a novel classification for upper airway collapse in sleep endoscopies

“…Since that classification, many appeared with many modifications. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 …”

Drug-Induced Sleep Endoscopy: Evaluation of a Selection Tool for Treatment Modalities for Obstructive Sleep Apnea

“…The degree of collapse can be reported as complete, partial, or none or (semi-)quantitative and the pattern of the obstruction as being circular/concentric, anteroposterior, or lateral. Different scoring systems have been introduced over the years, each with their own anatomical accents, grading of collapse, and in-and exclusion of collapse types [8,30,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. The working group of the European Position Paper reached a consensus on the fact that a scoring and classification system should include the following features: level (and/or structure), degree (severity), and configuration (pattern and direction) of the narrowing and obstruction [6,37].…”