Upper airway structural changes induced by CPAP in OSAS patients: a study using drug-induced sleep endoscopy

Liu

J of Otolaryngol - Head & Neck Surg

et al. 2020

Background The study aimed to evaluate the anatomical differences between positional and non-positional OSA, and to identify the potential predictors for distinguishing between these two types of OSA. Methods A cross-sectional study of 230 consecutive patients with OSA undergoing DISE (Drug-induced Sleep Endoscopy) was carried out at a tertiary academic medical center. The factors correlating with positional and non-positional OSA were analyzed, including clinical characteristics, polysomnography data, and DISE findings. Results Univariate analysis revealed that non-positional dependency was correlated with a higher BMI (p < 0.001), neck circumference (p < 0.001), modified Mallampati score (p = 0.003), AHI (p < 0.001), degree of velum concentric collapse (p = 0.004), degree of oropharyngeal lateral wall collapse (p < 0.001), and degree of tongue base anteroposterior collapse (p = 0.004). Multivariate analysis revealed that oropharyngeal lateral wall collapse (OR = 1.90, p = 0.027) was the only anatomical factor significantly predicted non-positional dependency in OSA patients. AHI (OR = 1.04, p < 0.001), although significant, made only a marginal contribution to the prediction of non-positional dependency. Conclusions Oropharyngeal lateral wall collapse was identified as the only anatomical predictor for non-positional dependency in OSA patients. Therefore, further treatment modalities should address the distinct anatomical trait between positional and non-positional OSA. Graphical abstract

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Role of drug-induced sleep endoscopy in evaluation of positional vs non-positional OSA

Liu

J of Otolaryngol - Head & Neck Surg

et al. 2020

“…Recent research showed the feasibility of a remotely controlled mandibular positioner for determination of the effective target protrusive position [64,65]. DISE can also be performed with active therapy such as MRA or PAP to assess (residual) upper airway collapse and/or snoring and to be able to determine additional treatment options [13,66,67].…”

Section: Evaluation and Inter-and Intrarater Variabilitymentioning

confidence: 99%

Drug-Induced Sleep Endoscopy: Evaluation of a Selection Tool for Treatment Modalities for Obstructive Sleep Apnea

2020

Obstructive sleep apnea (OSA) is a very common disorder with important day and nighttime symptoms and long-term effects on health. Different treatment modalities such as positive airway pressure (PAP), oral appliance therapy using custom-made, titratable mandibular advancement devices (MAD), different types of surgery and positional therapy have been introduced over the years, with patient preference and adherence to therapy being key elements in improving treatment outcomes. Several patient selection tools to improve treatment outcomes have been introduced and evaluated over the years. Drug-induced sleep endoscopy (DISE) is a procedure that provides real-time upper airway evaluation of the sites of flutter and upper airway collapse. This review focuses on the indications and contraindications for DISE, methods of sedation and evaluation, add-on maneuvers, and the results on patient selection and treatment outcomes. A PICO approach was used to clarify the aims of this review. DISE has the advantage of being easily accessible in most ENT practices and being 3-dimensional, dynamic, site specific, safe and it is valuable in selecting patients for upper airway surgery and oral appliance therapy. There is a strong interest for further standardization and exploration of the predictive value of this evolving technique.

“…During DISE examination, the physician not only analyses the airway in the supine sleep position. Various body positions and situations such as lateral sleep position, head turning, mandibular pull up, mouth opening, or continuous positive airway pressure (CPAP) titration can be applied [5–7]. These simulations provide crucial information for decision making [3, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

“…However, the conventional single channel DISE system usually records flexible endoscopic images only. Based only on the recorded video clips with the conventional DISE system, it is difficult to become aware of the surrounding information [7]. Without surrounding information, position change of patients or applied maneuver cannot be discriminated, not to mention the vital signs of patients.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of drug induced sleep endoscopy using multimodality monitoring system

et al. 2018

IntroductionTo overcome the limited readability of the conventional drug induced sleep endoscopy (DISE) system which only records flexible endoscopy images, we devised the Multimodality DISE System (MDS). MDS encompasses the monitoring systems for oxygen saturation, electrocardiogram, blood pressure, snoring intensity, and patient’s position. It enabled to record comprehensive situation of patients who underwent DISE. In this study, we compared the efficacy of MDS with that of the conventional DISE system.Methods and materialsTen patients underwent DISE at a tertiary hospital. DISE evaluated the airway of each patient in four positions; supine, supine with jaw thrust, right lateral decubitus, and left lateral decubitus. In addition, every examination was recorded by using both single monitoring system and MDS system. Five otolaryngologists interpreted the recorded examinations without knowledge of patient information (10 conventional DISE and 10 MDS). The visual analogue scale (VAS) scores for readability, reading times, ease of patient explanation and the ease of decision making were analyzed.ResultsMean VAS scores for readability of conventional DISE and MDS were 4.41+2.56 and 8.42+2.07 (p<0.001). Mean reading times for conventional DISE and MDS were 238.80+61.26 sec and 81.00+44.99 sec, respectively (p<0.001). MDS showed superiority in patient communication (p<0.001). MDS was helpful in decision making regarding patients with obstructive sleep apnea (p<0.001).ConclusionsMDS enhanced the readability of previously recorded DISE and enabled easier doctor-patient communication. In addition, MDS is more effective in decision making regarding patients with OSA. MDS has laid the groundwork for separating the DISE prescriber from the DISE performer.