Positional Awake Endoscopy Versus DISE in Assessment of OSA: A Comparative Study

Askar, Sherif M.; Quriba, Amal S.; Hassan, Ekram M.; Awad, Ali

doi:10.1002/lary.28391

Cited by 13 publications

(6 citation statements)

References 29 publications

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“…The recent trends in sleep surgery for OSA depend on accurate determination of upper airway collapse, and lateral pharyngeal wall collapse of recruited subjects was confirmed using sleep endoscopy in the present study. Recent study demonstrated a positional awake endoscopy can provide important surgical information with regard to level and pattern of upper airway obstruction [ 31 ]. We did not perform a positional awake endoscopy to determine the site of occlusion in subjects included in this study and in fact, better research results may be obtained by measuring the degree of obstruction during sleep with DISE and comparing it with the results of awake endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

et al. 2022

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Background Excessive collapse of the soft palate and lateral pharyngeal wall narrowing are established causes of loud snoring and sleep apnea in subjects with obstructive sleep apnea (OSA). Therefore, delicate surgical techniques are needed to reshape the soft palate and create sufficient tension in the lateral pharyngeal wall. This study aimed to determine the therapeutic outcome and favorable indications of soft-palate webbing flap pharyngoplasty in subjects with OSA and primary snoring. Methods A total of 174 subjects who underwent soft-palate webbing flap pharyngoplasty combined with uvulopalatal flap and septoturbinoplasty from August 2015 to February 2020 were included in this study. Medical records, including pre- and postoperative sleep parameters, were retrospectively reviewed. The primary outcome measure was the degree of improvement in AHI after surgery. Other outcomes were differences in surgical response rates, subjective visual analog score (VAS) for snoring, sleep quality, and complications. Results Polysomnographic results showed that apnea–hypopnea index (AHI) scores were significantly reduced from 39.6 ± 6.1 to 22.9 ± 3.6 following soft-palate webbing flap pharyngoplasty in 59 subjects, and overall success and response rates of this technique were analyzed with 71%. We found that the successful outcomes were observed in 50% of mild (n = 12) and 56% of moderate (n = 16) subjects with OSA subjects due to lateral pharyngeal wall collapse. The success rate of soft-palate webbing flap pharyngoplasty was relatively higher in subjects with mild and moderate OSA than those with severe OSA. Additionally, the mean VAS snoring scale was 4.7 and subjects’ primary snoring intensity significantly improved to 2.9 after soft-palate webbing flap pharyngoplasty. Subjective symptoms such as daytime sleepiness and sleep quality also showed improvement. Most complications were found to be minimal and improved by 1 month after the operation. Conclusion Our data demonstrate that soft-palate webbing flap pharyngoplasty is an effective treatment for OSA and primary snoring and may be a promising technique to reduce lateral pharyngeal wall collapse.

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Section: Discussionmentioning

confidence: 99%

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

et al. 2022

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“…In the literature [21,22], it is well reported how DISE can provide a good indication of the chances of success with MAD therapy. For many authors [23,24], DISE is a valid diagnostic and prognostic exam, but it has many limitations:…”

Section: Discussionmentioning

confidence: 99%

Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices

Gasparini

Saponaro

Todaro

et al. 2021

IJERPH

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Purpose: The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. Methods: This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. Results: We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. Conclusion: Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.

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“…Most authors have compared DISE findings with retrolingual MM. Only Askar et al 25 and Cavaliere et al 24 found this maneuver useful. On the contrary, based on our findings, retrolingual MM does not predict the collapse observed in DISE.…”

Section: Discussionmentioning

confidence: 99%

“…Several articles have compared physical awake and DISE findings, especially at the retropalatal level, [20][21][22][23] and to a lesser extent at the retrolingual level. [23][24][25] In this study, our aim was to elucidate if awake endoscopy may predict retrolingual collapse in OSA patients, therefore, DISE can be avoided.…”

Section: Discussionmentioning

confidence: 99%

Drug Induced Sleep Endoscopy Versus Awake Endoscopy in Retrolingual Obstruction Assessment in Obstructive Sleep Apnea Patients: A Comparative Study

Pérez-Martín¹,

Bosco²,

Navarro³

et al. 2021

Journal of Craniofacial Surgery

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: The aim of this study is to evaluate the correlation of retrolingual obstruction determined by drug induced sleep endoscopy (DISE) and awake endoscopy evaluation of Muller maneuver (MM) and lingual tonsil hypertrophy (LTH) in patients with obstructive sleep apnea. A prospective cohort of 100 patients with obstructive sleep apnea who underwent DISE was assessed. The inclusion criteria were age between 18 and 70 years, and apnea-hypopnea index higher than 5. Friedman staging, LTH and MM were determined by awake endoscopy, as other physical findings. The authors evaluated the correlation of retrolingual obstruction determined by DISE using velum oropharynx tongue, epiglottis (VOTE) and nose, oropharynx, hypopharynx, larynx (NOHL) classification. When retrolingual MM was assessed, significant changes between awake and DISE were observed (P = 0.000). Conversely, Friedman stage had no significant changes to DISE retrolingual findings (P = 0.868). Analyzing LTH and DISE retrolingual findings according to NOHL and VOTE, if a cutoff value was established at 50%, DISE findings differ from awake: NOHL (P<0.001) and VOTE (P = 0.004). Nevertheless, if a restrictive cutoff at 75% was attached, DISE findings were similar to awake: NOHL (P = 0.124) and VOTE (P = 0.123). This study demonstrates that awake endoscopy determining LTH and Friedman stage is a mild predictor of collapse at retrolingual level, showing significant correlation to DISE only when severe retrolingual collapse is present. Our findings suggest that in-office awake endoscopy may have certain predictive value to select surgical patients.

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Positional Awake Endoscopy Versus DISE in Assessment of OSA: A Comparative Study

Cited by 13 publications

References 29 publications

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

Optimal application of soft-palate webbing flap pharyngoplasty combined with nasal surgery for surgical treatment of primary snoring and obstructive sleep apnea

Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices

Drug Induced Sleep Endoscopy Versus Awake Endoscopy in Retrolingual Obstruction Assessment in Obstructive Sleep Apnea Patients: A Comparative Study

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