Sleep nasendoscopy: a 10-year retrospective audit study

Abstract

Sleep nasendoscopy was conceived at the Royal National Throat, Nose and Ear Hospital, UK in 1991, and has remained fully implemented in patient selection for targeted treatment of the spectrum of sleep-disordered breathing. The senior authors (B.T.K. and P.B.) have been performing sleep nasendoscopy together for over 10 years, and we look back at their decade's experience. A retrospective audit study based on case notes was performed over a 10-year period (1995-2005) in a tertiary-referral practice setting. Case notes were retrieved on all patients who had undergone sleep nasendoscopy during the study period, and agreed data were extracted and analyzed. A total of 2,485 sleep nasendoscopies were performed in patients with a mean age of 44.1 years, a 4:1 male preponderance, and a mean body mass index of 27.3 kg m(-2). Sleep nasendoscopy grading correlated well with apnoea-hypopnoea index and mean oxygen desaturation. Such grading helped us define and discuss treatment options with patients. After a median follow-up period of 518 days, 72% of patients reported feeling better; 26% of patients reported no change; and only 2% of patients reported feeling worse after treatment. Sleep nasendoscopy has proved to be a useful adjunctive method to identify the anatomical site of snoring, not to mention upper airway collapse, and remains integral to our tertiary-referral practice. It has allowed us quality assessment of the dynamic anatomy of sleep-disordered breathing that most closely and cost-effectively simulates the natural situation of patients. And for targeted treatment, such assessment has been fundamental.

Interventional Drug-Induced Sleep Endoscopy: A Novel Technique to Guide Surgical Planning for Obstructive Sleep Apnea

“…Although DISE has been shown to be reliable, some critics of the technique suggest that sedative-induced sleep only provides a small window into the complex and variable patterns of natural sleep. [25][26][27] The present study demonstrates a more dynamic approach to DISE. The surgeon actively manipulated the upper airway with a NPT to better understand the interplay of the different sites of obstruction.…”

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

“…[2][3][4] Various sedation methods have been used to allow for the performance of DISE. Roblin introduced target-controlled infusion (TCI) of propofol to DISE to allow for better control of the sedation level.…”

Investigation of the Source of Snoring Sound by Drug-Induced Sleep Nasendoscopy

“…Accurately identifying the main source of snoring sound is important for surgical success [9]. DISN was first described by Croft and Pringle [10] in 1991, and this procedure allows a direct visualization of the sites of vibration or obstruction in a sleeping patient.…”

“…Propofol and midazolam are the two main drugs which are commonly used in DISN [3,9,21]. Kotecha et al [9] found that the titrated administration of propofol combined with midazolam worked well in DISN. However, the disadvantage of midazolam is its longer elimination and respiratory depression effect [22].…”

“…DISN is the only method able to directly visualize the vibrating structures in the pharyngeal cavity during sleep [9,13,21], and thus, can be helpful in the treatment of snoring [24]; however, it also has some flaws and remains controversial. Firstly, it is invasive, and intravenous sedation should be used.…”