Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug‐induced sleep endoscopy

Torre, C. de la; Liu, Stanley Yung‐Chuan; Kushida, Clete A.; Nekhendzy, Vladimir; Huon, Leh-Kiong; Capasso, Robson

doi:10.1111/coa.12851

Cited by 34 publications

(37 citation statements)

References 19 publications

(33 reference statements)

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“…This approach could identify a pattern or place of airway collapse that may require varying pressures different from the one the patient is using, as well as anatomical factors that may be corrected to help with compliance 47 ,…”

Section: The Vote Classificationmentioning

confidence: 99%

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Strohl

Yamauchi

Peng

2017

Curr Sleep Medicine Rep

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Purpose The literature on hypoglossal nerve stimulation (HNS) for the treatment of moderate-to-severe obstructive sleep apnea (OSA) was reviewed from 2014, the time of FDA approval for the Inspire Systems device, to 2017 for themes that might be useful conceptually and practically in the consideration of this new non-anatomic surgical therapy. Recent Findings there are now further follow-up articles since the 12-month results for Apnea Reduction (STAR) trial of the Inspire device, and post-approval publications which report similar and/0r improved AHI outcomes. Other emerging themes include drug-induced sedation endoscopy (DISE) as a tool in assessment of eligibility and a more detailed understanding of mechanisms for an HNS effects. Summary The post-STAR literature provides guidelines for an integrated coordination of medicine and surgery to appropriately screen and manage patients.

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Section: The Vote Classificationmentioning

confidence: 99%

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Strohl

Yamauchi

Peng

2017

Curr Sleep Medicine Rep

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“…An interesting finding of the present study is the persistence of epiglottis collapse in 43% (n = 6/ 14) of the patients after MMA surgery. Regarding the role of the epiglottis in adult OSA and snoring patients, knowledge is still limited . Although its prevalence in OSA seems to be greater than previously reported, more research is required to understand its role in OSA and, consequently, the best way to treat it .…”

Section: Discussionmentioning

confidence: 96%

“…Regarding the role of the epiglottis in adult OSA and snoring patients, knowledge is still limited. [35][36][37] Although its prevalence in OSA seems to be greater than previously reported, more research is required to understand its role in OSA and, consequently, the best way to treat it. 36 According to previous research, the epiglottis has been implicated in 12% of cases of snoring, and the sound originating from it has a higher pitch than palatal snoring.…”

Section: Discussionmentioning

confidence: 97%

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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Objectives/Hypothesis To evaluate upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) and maxillomandibular advancement (MMA) surgery outcome, paying particular attention to the DISE phenotype complete concentric collapse at the level of the palate (CCCp). Study Design Prospective case series. Methods Nineteen patients diagnosed with obstructive sleep apnea (OSA) prospectively underwent mandibular advancement device (MAD) treatment followed by MMA surgery. UA collapse patterns were evaluated before and after MMA surgery. Baseline apnea‐hypopnea index (AHI) was compared with AHI during MAD treatment and after MMA surgery. UA collapse patterns and the presence of baseline CCCp were assessed. AHI differences between patients with and without CCCp after MMA surgery were compared. Results In 14 patients, a full dataset was obtained: 8/6 (male/female), mean age = 51 ± 7 years, body mass index (BMI) = 25.6 ± 3.7 kg/m2, and baseline AHI = 40.2 ± 25.6 per hour of sleep. MMA surgery reduced AHI to 9.9 ± 7.2 per hour of sleep (P = .0001). Eight patients benefited from additional AHI reduction compared to MAD treatment (P = .0113). Six out of 14 (43%) patients showed baseline CCCp. Baseline patient characteristics (age, BMI, and AHI) did not significantly differ between patients with and without CCCp. AHI was equally reduced after MMA, whether (P = .0145) or not (P = .0075) CCCp was present at baseline. All patients showed resolution of CCCp (P = .0159) during postoperative DISE. Conclusions CCCp seems not to be a negative predictor for MMA surgery outcome measured by AHI reduction. Furthermore, MMA is likely to eliminate CCCp. Therefore, MMA might be a solution for OSA patients showing CCCp and broadens the perspective for personalized medicine and combination therapy. However, a large sample is required for definitive results. Level of Evidence 4 Laryngoscope, 130:E268–E274, 2020

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“…Two exceptions in the treatment of airway collapse by CPAP are nasal valve and epiglottis collapses, in which CPAP does not have optimal response and surgery commonly lead to improvement in clinical symptoms and OSA severity [15] , [16] , [17] . Based on the widely used nose-VOTE system, surgery takes advantage in treating obstruction/collapse of the nose, velopharynx, and epiglottis [18] , [19] , [20] , by contrast, CPAP has superiority in treating collapse from the oropharyngeal lateral wall and tongue [21] . Fig.…”

Section: Principle In Decision-making Between Cpap and Surgerymentioning

confidence: 99%

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

Lee

Hsin

et al. 2019

Biomedical Journal

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Obstructive sleep apnea (OSA) is a common disease in adults, which influences human relations, quality of life and associates with major complications. Continuous positive airway pressure (CPAP) is the gold standard treatment modality in OSA patients. For patients incompliant or unwilling to CPAP therapy, surgery is an alternative treatment. Sleep surgery for OSA include intrapharyngeal surgery, extrapharyngeal surgery and bariatric surgery addressing upper airway soft tissue, maxillofacial bone, and obesity, respectively. Among sleep surgeries, intrapharyngeal surgery (soft tissue surgery) is widespread used and serves overwhelming majority in OSA surgical patients. Despite the popularity of intrapharyngeal surgery, its outcomes can be influenced by multiple factors and consequently need conjunctive remedy to enhance at the short-term and sustain in the long-term. In this article, we introduce updated indications for treating OSA, practical principle in decision-making between CPAP and surgery, hybrid procedures in treating obstruction at the nose, palate, tongue and epiglottis, and postoperative integrated treatment including oropharyngeal myofunctional therapy (local), positional therapy (regional), and body weight reduction (systemic), and circadian rhythm (central). In summary, intrapharyngeal surgery is a target-oriented procedure that needs to be performed precisely and combines with integrated treatment as a holistic care for OSA patients.

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Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug‐induced sleep endoscopy

Cited by 34 publications

References 19 publications

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

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