Meta‐Analysis of Obstruction Site Observed With Drug‐Induced Sleep Endoscopy in Patients With Obstructive Sleep Apnea

Abstract

Objective To perform a meta‐analysis on the distribution and characteristics of the obstructive site in patients with obstructive sleep apnea (OSA) using data from a variety of published studies that evaluated the obstruction with drug‐induced sleep endoscopy (DISE). Methods A literature search was performed to identify studies in which DISE was used to identify the obstruction site in adult patients with OSA, and the obstruction site was described in sufficient detail. Four items were evaluated in the meta‐analysis: the obstruction site, closing direction of the soft palate, degree of closure, and percentage of single‐level obstructions. Results A total of 2,950 patients from 19 studies were included. In the two‐level classification system, the rate of obstruction was 91.6% for the soft palate and 58.0% for the tongue base. In the four‐level classification system, the rate of obstruction was 84.1% for soft palate, 32.8% for the tonsil, 51.6% for the tongue base, and 34.3% for the epiglottis. The soft palate closed in the anteroposterior direction at a rate of 44.4% and in the concentric direction at a rate of 46.5%. The rate of a closure of 75% or more was 69.3% for the soft palate and 56.8% for the hypopharynx. The percentage of single‐level obstructions was 42.5%. Conclusion The soft palate is obstructed in most patients with OSA, and the tongue base is obstructed in half of the patients. In addition, multilevel obstructions including the tonsil, lateral pharyngeal wall, or epiglottis are common; thus, these areas must be checked carefully. Level of Evidence NA Laryngoscope, 129:1235–1243, 2019

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

“…5 Many studies have been published describing patterns of obstruction observed during DISE and associations with baseline OSA severity. 6-9 In addition, there is a growing body of literature describing the impact of DISE on treatment decision making in adult OSA 10-13 and the utility of DISE in predicting surgical outcomes. 14-17…”

Computer‐Assisted Quantitative Analysis of Drug‐Induced Sleep Endoscopy for Obstructive Sleep Apnea/Hypopnea Syndrome

“…21 Lee and Cho presented a meta-analysis (most studies used qualitative classification with heterogeneity) and found that the upper airway usually had multilevel rather than single-level obstructions; furthermore, they reported that the soft palate was the most common obstructive site and that the tongue base was obstructed in half of the patients. 22 They also stated that the rate of an obstruction ≥75% (defined as significant obstruction) was 69.3% for the soft palate and 56.8% for the tongue base, indicating that significant obstructions occurred at these 2 levels. As compared with our study, the rate of significant obstruction was 56% for the RP level, 55% for the oropharyngeal level, 15% for the RG level, and 33% for the RE level.…”

Prevalence and patterns of tongue deformation in obstructive sleep apnea: A whole‐night simultaneous ultrasonographic and polysomnographic study

“…Currently, an increasing number of investigators have advocated drug‐induced sedated endoscopy (DISE) as a method to evaluate the site of obstruction in OSA (Dijemeni, D'Amone, & Gbati, 2017; Yalamanchili et al., 2019). Lee and Cho (2019) reviewed the obstruction site observed with DISE by using the four‐level classification system in patients with OSA. They reported a highly variable rate of obstruction for the tongue base, ranging from 4% to 88%, with an average tongue obstruction rate of 51.6%.…”