Time-dependent changes in the obstruction pattern during drug-induced sleep endoscopy

Heo, Sung Jae; Park, Chang Mook; Kim, Jung Soo

doi:10.1016/j.amjoto.2013.08.017

Cited by 28 publications

(23 citation statements)

References 24 publications

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“…(ii) As a UA collapsibility evaluation method, DISE itself has some limitations, such as controversy about the reliability of observed obstructive sites, 48 that it might not improve surgical success rates, 49 and variable findings with prolonged observation time or different sedative drugs. 44,50 Dexmedetomidine was used for sedation, and differences in tongue base collapse related to propofol or midazolam use have already been identified. Nevertheless, the velum collapse pattern was similar in response to the three drugs, 51 enabling extension of the findings in this study to DISE with these drugs.…”

Section: Discussionmentioning

confidence: 99%

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Zhao

Viana

et al. 2020

NSS

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Identification of upper airway (UA) obstruction based on pharyngeal factors is important for obstructive sleep apnea (OSA) evaluation. This study is to assess the association between UA collapse characteristics and Friedman tongue position (FTP) in patients with OSA through drug-induced sleep endoscopy (DISE). Patients and Methods: Retrospective study in individuals with OSA who were intolerant to continuous positive airway pressure (CPAP) treatment, submitted to DISE between June 1, 2013, and July 31, 2017. All subjects were classified as having an FTP grade of I to IV, and the velum, oropharynx, tongue base, epiglottis (VOTE) classification was used to analyze the DISE findings. UA collapse characteristics by DISE and FTP grading were compared between groups. The associations between specific DISE findings and FTP were analyzed. Results: In total, 205 patients were assessed. A positive and significant correlation was identified between the presence of retropalatal complete concentric collapse (CCC) and FTP grade, according to the following distributions: I, 17.4%; II, 22.9%; III, 33.7%; and IV, 48.7% (P = 0.014). A logistic regression model revealed that CCC was associated with FTP grade IV. After adjusting for age, sex, body mass index (BMI), and tonsil size (TS), the grade IV individuals had a 4.4-fold higher risk of having CCC than grade I individuals (P = 0.026). Multiple collapse sites and palatopharyngeal or combined (palatopharyngeal and hypopharyngeal) collapse were more prevalent in grade IV individuals. Conclusion: OSA patients intolerant to CPAP have a strong positive correlation between the FTP grade and presence of retropalatal CCC. FTP grade IV is an independent risk factor for velum-CCC, controlling for sex, age, BMI, and TS grade.

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Section: Discussionmentioning

confidence: 99%

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Zhao

Viana

et al. 2020

NSS

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“…Hong demonstrated that increasing sedation (mean BIS concentration increasing from 77.4± 4.5 to 61.9±6.9) increased the severity of obstruction but did not induce additional obstruction sites [15]. On the other hand, Heo showed that prolonging the examination, and thereby increasing the total dose of Midazolam, could increase the number of obstruction sites (soft palate, pharyngeal walls, and base of the tongue) and the obstruction severity and also change the obstruction mechanism [16]. It is difficult to determine the individual target concentration for each patient.…”

Section: Discussionmentioning

confidence: 94%

Are the obstruction sites visualized on drug-induced sleep endoscopy reliable?

et al. 2015

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“…DISE was performed as described previously. 8 It was performed at an outpatient clinic by the same otorhinolaryngologist for all patients to prevent technical variations. The nasal mucosa was topically anesthetized and shrunk using gauze soaked with lidocaine (4%) and epinephrine (0.1%).…”

Section: Drug-induced Sleep Endoscopymentioning

confidence: 99%

“…8,9 Moreover, it shows the obstruction pattern during sleep, unlike the Müller maneuver or cephalometry, and it is performed without radiation exposure unlike video fluoroscopy or multidetector computed tomography. 8,9 Moreover, DISE has also been reported to be a useful tool to predict the effect of MAD on OSA when a modified jaw-thrust maneuver (MJTM) is performed during DISE because MAD and MJTM utilize the same mechanism, namely, the protrusion of the mandible. 6,10 In the clinical setting, however, the MJTM may cause pain and discomfort even when performed gently, and may affect the depth of sedation due to discomfort even during DISE.…”

Section: Introductionmentioning

confidence: 99%

The Effect of the Modified Jaw-Thrust Maneuver on the Depth of Sedation During Drug-Induced Sleep Endoscopy

Park

Kim

Heo

2019

Journal of Clinical Sleep Medicine

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Study Objectives: The modified jaw-thrust maneuver (MJTM) during drug-induced sleep endoscopy (DISE) is known to predict the treatment effect of mandibular advancement devices. However, its effect on the depth of sedation and potential to provoke arousal by awakening patients during the maneuver has not been studied so far. This study investigated the effect of the MJTM on the depth of sedation during DISE. Methods: Forty patients on whom the MJTM was performed during DISE were included. The effect of the maneuver was evaluated at the levels of the velum, lateral wall of the oropharynx, base of the tongue, and epiglottis. Obstruction was defined as the collapse of the upper airway exceeding 75%, and improvement with the MJTM was defined as the widening of the upper airway by more than 50% during the maneuver. A bolus injection of midazolam was used to induce sedation and control the depth of sedation (bispectral index value of 60 to 80). Results: Obstructions were present in the velum of all patients, lateral wall of the oropharynx of 13 patients, base of the tongue of 28 patients, and epiglottis of 6 patients. After the MJTM, improvement of the obstruction was observed in 57.5%, 61.5%, 82%, and 66.7% of patients with velum, lateral wall of the oropharynx, base of the tongue, and epiglottis obstructions, respectively. An increase in the bispectral index value of more than 20 was observed in 8 patients. Four patients awakened during the procedure. Conclusions: The MJTM significantly relieved obstruction during DISE, especially at the base of the tongue. However, this might have been caused by an increase in the degree of awakening during the maneuver. Therefore, MJTM's effect on the depth of sedation may help in improving the degree of airway obstruction.

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Time-dependent changes in the obstruction pattern during drug-induced sleep endoscopy

Cited by 28 publications

References 24 publications

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Are the obstruction sites visualized on drug-induced sleep endoscopy reliable?

The Effect of the Modified Jaw-Thrust Maneuver on the Depth of Sedation During Drug-Induced Sleep Endoscopy

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