Drug-Induced Sleep Endoscopy as a Selection Tool for Surgical Management of Obstructive Sleep Apnoea Syndrome: Our Personal Experience

Abstract

30 Polysomnography proved OSA patients, age between 20 and 60 years have been selected for Drug Induced Sleep Endoscopy (DISE) after taking informed consent for proposed surgery. Inj propofol infusion given throughout the DISE procedure and upper airway nasal endoscopy performed for assessment of site of collapse (Retropalatal, Retrolingual, Hypopharyngral), type of collapse (circumferential, lateral) and severity of obstruction, Lowest SpO, apnoeic episodes and DISE findings were recorded. Out of these thirty patients 90% were male and 10% were female, observed that 66.7% of males and 40.7% of females belonged to 31-40 age group, and BMI of 63.3% of patient population were overweight, 20% were obese and 5% were normal. Mean fall in SpO was 90.20 ± 2.77 in normal subjects, 83.05 ± 5.14 in overweight subjects and 68.83 ± 9.11 in obese subjects. Normal subjects had 0.4 ± 0.9 apnoeic episodes, overweight subjects had 0.9 ± 1.6 episodes and obese subjects had 4.0 ± 2 apnoeic episodes. We observed that 40% had retropalatal airway collapse, 23.3% had airway obstruction at the base of the tongue, 20% had airway obstruction with floppy epiglottis, 12% multiple level collapse, 6.7% of patient population had grade 4 enlarged tonsils, 3.3% had lateral pharyngeal wall collapse, and 0% hypopharyngeal collapse. Out of 30, 29 Patients underwent surgery (Expansion sphincter pharyngo plasty-14, Hyoid advancement-4, Uuvulopalatoplasty-10, Epiglottic surgery-6, Zeta pharyngoplasty-2, midline glossectomy-3, Endoscopic septoplasty-5, Inferio turbinoplasty-2, LASSER Assisted lingual tonsillectomy-1), All these 29 patient were followed for 3 months, at the end of 3rd month again Each subject was evaluated with a baseline Epworth Sleepiness Scale and LEVEL-3 PSG, the results were impressive with statistically significant. DISE is a dynamic, safe, and easy-to-perform technique that visualizes, the anatomical sites of snoring or apneas for assessment site of collapse (Retropalatal, Retrolingual, Hypopharyngral), type of collapse (Circumferential, Lateral) and severity of obstruction and guides the design of a tailor-made treatment plan for a OSA SURGEON in individual cases, which will improves perioperative outcome.

Challenges and perspectives in obstructive sleep apnoea

“…Open questions regarding alternatives to CPAP include the prediction of success, long-term outcomes and health economics [24]. There is an urgent need to define reliable predictors of treatment success and long-term outcomes [172][173][174][175][176].…”

Effectiveness of drug-induced sleep endoscopy in improving outcomes of barbed pharyngoplasty for obstructive sleep apnea surgery: a prospective randomized trial

“…Patient selection and choice of surgical procedure for OSA have traditionally relied on static examination of the awake patient, and thus may not accurately predict sites of obstruction during the sleeping state [15,16,18,19]. Awake upper airway endoscopy can be done safely in the office setting and it is useful for evaluating any anatomic variants of the upper airway structures such as deviated nasal septum, turbinate hypertrophy, and adenotonsillar hypertrophy as well as for ruling out pathological obstruction such as nasal polyps and tumors [15,16,[20][21][22][23][24][25][26][27][28][29][30].…”

“…The efficacy of mandibular advancement (pull-up maneuver) was tested in each patient during the DISE [16][17][18][19].…”

“…Delta AHI (postoperative AHI -preoperative AHI), Delta ODI (postoperative ODI -preoperative ODI), and Delta LOS (postoperative LOS -preoperative LOS) were calculated in order to express the value of surgical efficacy and to compare the groups of patients. Therapeutic success was defined according to Sher's criteria, that is, the achievement of a postoperative value of AHI < 20 and a 50% improvement in the preoperative AHI value [1,[15][16][17][18][19][20]. This is the most used score to analyzed results of OSA surgery in the existing literature [31,32].…”

“…DISE allows the identification of sites, types, and patterns of upper airway obstructions/collapse during pharmacologically induced sleep [15][16][17]. Bharathi et al [18] employed the DISE as a selection tool for the surgical management of OSA and observed that 40% of enrolled patients had retropalatal airway collapse, 23.3% had airway obstruction at the base of the tongue, 20% had airway obstruction with floppy epiglottis, and 12% had multiple level collapse. Moreover, DISE examination has proved to be superior to the awake fibro-laryngoscopy for identifying sites and collapse patterns in patients with OSA [13,14].…”