Upper airway collapse during drug induced sleep endoscopy: head rotation in supine position compared with lateral head and trunk position

Abstract

Drug induced sedated sleep endoscopy (DISE) is often employed to determine the site, severity and pattern of obstruction in patients with sleep apnea. DISE is usually performed in supine position. We recently showed that the obstruction pattern is different when DISE is performed in lateral position. In this study, we compared the outcomes of DISE performed in supine position with head rotated, with the outcomes of DISE performed with head and trunk in lateral position. The Prospective study design was used in the present study. Sixty patients with OSA (44 male; mean apnea hypopnea index (AHI) 20.8 ± 17.5 events/h) underwent DISE under propofol sedation. Patients were placed in lateral position, and the upper airway collapse was evaluated. The patients were then placed in supine position with the head rotated to the right side. DISE outcomes were scored using the VOTE classification system. In lateral position, nine patients (15.0%) had a complete antero-posterior (A-P) collapse at the level of the velum, nine had a partial A-P collapse. During head rotation and trunk in supine position, at the level of the velum, four patients (6.7%) had a complete A-P collapse, while two patients (3.3%) had a partial A-P collapse. For all other sites, the patterns of collapse were not significantly different between head rotation and lateral position. During DISE, rotation of the head in supine position, and lateral head and trunk position present similar sites, severity and patterns of upper airway collapse, with the exception of collapse at the level of the velum. Here the severity of A-P collapse is less severe during head rotation than in lateral head and trunk position.

Epiglottis collapse in adult obstructive sleep apnea: A systematic review

“…They also identified the tongue base and the epiglottis as the primary sites of airway size improvement when patients were evaluated in the lateral position as compared to the supine position. Safiruddin et al reported that lateral positioning of the head is associated with decreased frequency of complete anteroposterior collapse at tongue base and epiglottis in patients with both positional and nonpositional OSA . Finally, Kent et al found in their study that out of 11 patients with epiglottis collapse, only four of them were successfully treated with oral appliances for this problem …”

“…Positional therapy, on the other hand, does seem to consistently offer good results in treating epiglottis collapse and to be more effective than oral appliances in OSA patients with this problem. 24,36,37 Resection of the epiglottis provides the most effective and predictable solution in cases when a floppy epiglottis collapses and obstructs the airway during sleep. 15,22,23,[28][29][30]32,33 Studies evaluating epiglottectomy in snoring patients with a floppy epiglottis have shown that the procedure decreased their snoring.…”

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

“…Studies examining the influence of head rotation, on “severity” and patterning of anterior-posterior (AP) and concentric collapse (CC), suggested that at the level of the velum there is a qualitatively less “severe” AP collapse with head rotation 46 .…”

Organization and logistics of drug-induced sleep endoscopy in a training hospital

“…In case an oral device is considered as treatment option, a jaw thrust is performed. Similarly, if positional therapy may be considered the DISE will also be performed with the patient ('s head) in a lateral position [6,8,9,11,12]. 4.…”