scholarly journals 0561 Differences in Nasopharyngoscopic Airway Form Between Awake and Sleep, Sitting and Recumbent Position and Techniques

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A215-A215
Author(s):  
Y Nishimura ◽  
M Hamed
Keyword(s):  
Airway Obstruction ◽  
Fiber Optic ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Recumbent Position ◽  
Drug Induced ◽  
Airway Narrowing ◽  
Flexible Fiber ◽  
Obstructive Sleep ◽  
Anterior Posterior

Abstract Introduction To examine and compare the information derived from flexible fiber-optic nasopharyngoscopy in awake mimic snoring (AMS), Müller’s Maneuver (MM) and drug-induced sleep endoscopy (DISE), to determine if AMS and MM can be used in substitution for DISE as a streamlined method. We investigated their relation with the level and pattern of obstruction detected on AMS, MM and DISE. Methods This is a retrospective study of 15 obstructive sleep apnea patients with apnea hypopnea index from 8.3 to 105.2, ages 20 to 80 were included. Each patient underwent polysomnography and thorough a physical examination, including flexible nasopharyngoscopy with AMS, MM and DISE. Airway obstruction on these endoscopic procedures were described according to airway level and pattern of obstruction. They were classified 5 different types; Uvula type: anterior-posterior vibration of the uvula, no airway obstruction; L-R velum type: lateral (the left and right directions) airway narrowing at velum level, no airway obstruction; A-P velum type: anterior-posterior total airway obstruction at velum level; Tonsillar type: total airway obstruction at pharyngeal level; Circumferential type: circumferential total airway obstruction at velum level. AMS and MM were performed with patients in sitting and in recumbent position. DISE was performed only in recumbent position. Results In review of the three procedures, the results were much different. Airway was obstructed in all cases(100%, 15 of 15)in DISE, but not all cases in AMS and MM. When tonsillar type was seen in AMS, it was also seen in MM and DISE(100%, 5 of 5). Conclusion Flexible fiber-optic nasopharyngoscopy appears to be useful for evaluating airway obstruction. It might be not suitable to use AMS and MM in substitution for DISE(except tonsillar type). Muscle tonic relaxation of the upper airway between AMS, MM and DISE might be different (DISE>MM>AMS, recumbent>sitting). Support  

Clinical Protocol in the Multidisciplinary Setting

2021 ◽  
pp. 65-82
Author(s):  
Jonathan Waxman ◽  
Kerolos Shenouda ◽  
Ho-sheng Lin ◽  
Safwan Badr
Keyword(s):  
Physical Examination ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Drug Induced ◽  
Upper Airway Stimulation ◽  
Airway Narrowing ◽  
Airway Anatomy ◽  
Airway Collapse ◽  
Upper Airway Collapse ◽  
Obstructive Sleep

This chapter describes a presurgical protocol for patients with moderate to severe obstructive sleep apnea (OSA) who plan to undergo treatment with upper airway stimulation (UAStim). Patients must receive an initial evaluation including a medical and sleep history and physical examination focused on characteristics suggestive of upper airway narrowing. Criteria related to UAStim therapy and possible exclusion from implantation may be considered at this point. Some patients may be referred to a sleep specialist, but all must undergo in-laboratory or at-home polysomnography to diagnose OSA. Following an OSA diagnosis, treatment with continuous or auto-titrating positive airway pressure should be initiated. Unfortunately, CPAP adherence is low, and while there are several nonsurgical alternatives, many patients who are unable or unwilling to use CPAP will seek surgical treatment. Patients who are referred to otolaryngology for evaluation for UAStim therapy should undergo a medical and sleep history and physical examination including flexible fiberoptic laryngoscopy to evaluate upper airway anatomy. Patients must next undergo drug-induced sleep endoscopy (DISE), during which the upper airway is directly visualized in the operating room with fiberoptic endoscopy under sedation. The most common classification system to describe the location and pattern of upper airway collapse observed during DISE is the Velum, Oropharyngeal walls, Tonsils, Epiglottis (VOTE) system. Patients older than 22 years of age, with an apnea–hypopnea index between 15 and 64 (with central/mixed apneas <25% of the total), a body mass index <32 m/kg2, and without palatal complete concentric collapse may be offered UAStim treatment.

scholarly journals OSA Upper Airways Surgery: A Targeted Approach

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 690
Author(s):  
Andrea De Vito ◽  
B. Tucker Woodson ◽  
Venkata Koka ◽  
Giovanni Cammaroto ◽  
Giannicola Iannella ◽  
...  
Keyword(s):  
Treatment Options ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Upper Airways ◽  
Drug Induced ◽  
Pharyngeal Wall ◽  
Obstructive Sleep ◽  
Number Of Patients ◽  
Methodological Bias

Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.

Pulse Arterial Tone and Airway Obstruction in Sleep Apnea

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P83-P83 ◽  
Author(s):  
Jose E Barrera ◽  
Andrew B. Holbrook ◽  
Juan Santos ◽  
Gerald R Popelka
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Real Time ◽  
Upper Airway ◽  
Airway Narrowing ◽  
Obstructive Sleep ◽  
Airway Obstructions ◽  
Surgical Treatments ◽  
Arterial Tone ◽  
Continuous Pulse

Objective Determine if continuous pulse arterial tone (PAT) amplitude correlates with upper airway obstructions observed during simultaneous real-time magnetic resonance imaging (RT-MRI) in subjects with Obstructive Sleep Apnea (OSA). Methods A prospective series of 20 subjects diagnosed with mild to severe OSA by polysomnography, Fujita classification, Functional Outcomes of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Score (ESS) underwent continuous RT-MRI during a 90-minute nap without sedation. The upper airway at the mid-saggittal plane was visualized in real time (33 fps) using a sliding window algorithm (RTHawk system). Continuous pulse arterial tone amplitude was simultaneously monitored (Watch-PAT, Itamar Inc, Israel). Results Changes in PAT amplitude were in phase with upper airway narrowing and obstruction from tongue, soft palate, and epiglottis movements. Airway obstructive events occurred coincident to 60% or greater decreases in PAT amplitude. The image sequence associated with each PAT amplitude decrease demonstrated the precise location of the obstruction. Pre-surgical site of airway obstruction and post-surgical cause of persistent obstruction was clearly identified. Conclusions RT-MRI with simultaneous and continuous PAT signal recording during natural sleep is an innovative and improved method for more precisely characterizing airway obstructions in patients with mild to severe OSA. This approach may be valuable for planning surgical treatments, potentially improving the success of these procedures.

scholarly journals Outcomes of Tongue Base Reduction and Lingual Tonsillectomy for Residual Pediatric Obstructive Sleep Apnea after Adenotonsillectomy

2019 ◽  
Vol 23 (04) ◽  
pp. e415-e421
Author(s):  
Seckin Ulualp
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Tongue Base ◽  
Apnea Hypopnea Index ◽  
Drug Induced ◽  
Posterior Displacement ◽  
Obstructive Sleep ◽  
Lingual Tonsillectomy ◽  
Tongue Base Reduction

Introduction Upper airway obstruction at multiple sites, including the velum, the oropharynx, the tongue base, the lingual tonsils, or the supraglottis, has been resulting in residual obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (TA). The role of combined lingual tonsillectomy and tongue base volume reduction for treatment of OSA has not been studied in nonsyndromic children with residual OSA after TA. Objective To evaluate the outcomes of tongue base volume reduction and lingual tonsillectomy in children with residual OSA after TA. Methods A retrospective chart review was conducted to obtain information on history and physical examination, past medical history, findings of drug-induced sleep endoscopy (DISE), of polysomnography (PSG), and surgical management. Pre- and postoperative PSGs were evaluated to assess the resolution of OSA and to determine the improvement in the obstructive apnea-hypopnea index (oAHI) before and after the surgery. Results A total of 10 children (5 male, 5 female, age range: 10–17 years old, mean age: 14.5 ± 2.6 years old) underwent tongue base reduction and lingual tonsillectomy. Drug-induced sleep endoscopy (DISE) revealed airway obstruction due to posterior displacement of the tongue and to the hypertrophy of the lingual tonsils. All of the patients reported subjective improvement in the OSA symptoms. All of the patients had improvement in the oAHI. The postoperative oAHI was lower than the preoperative oAHI (p < 0.002). The postoperative apnea-hypopnea index during rapid eye movement sleep (REM-AHI) was lower than the preoperative REM-AHI (p = 0.004). Obstructive sleep apnea was resolved in children with normal weight. Overweight and obese children had residual OSA. Nonsyndromic children had resolution of OSA or mild OSA after the surgery. Conclusions Tongue base reduction and lingual tonsillectomy resulted in subjective and objective improvement of OSA in children with airway obstruction due to posterior displacement of the tongue and to hypertrophy of the lingual tonsils.

Mechanisms of Airway Obstruction in Robin Sequence: Implications for Treatment

1992 ◽  
Vol 29 (3) ◽  
pp. 224-231 ◽  
Author(s):  
Aaron E. Sher
Keyword(s):  
Airway Obstruction ◽  
Fiber Optic ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Robin Sequence ◽  
Flexible Fiber ◽  
Optic Endoscopy

Though the problems associated with Robin sequence may be numerous, especially if the primary cause of the sequence is a multiple anomaly syndrome, the most acute problems in affected newborns Is upper airway obstruction. Until recently It has been tacitly assumed that glossoptosis is always the cause of the airway obstruction. More recent evidence has shown that the sources of airway obstruction are multiple and the cause of apnea heterogeneous. The purpose of this paper is to report the mechanisms of upper airway obstruction In 53 Infants with Robin sequence. The use of flexible fiber optic endoscopy to specify treatment is discussed in detail.

scholarly journals Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions

2014 ◽  
Vol 45 (1) ◽  
pp. 129-138 ◽  
Author(s):  
Faiza Safiruddin ◽  
Olivier M. Vanderveken ◽  
Nico de Vries ◽  
Joachim T. Maurer ◽  
Kent Lee ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Hypoglossal Nerve ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Therapeutic Level ◽  
Drug Induced ◽  
Upper Airway Stimulation ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Anterior Posterior

Upper-airway stimulation (UAS) using a unilateral implantable neurostimulator for the hypoglossal nerve is an effective therapy for obstructive sleep apnoea patients with continuous positive airway pressure intolerance. This study evaluated stimulation effects on retropalatal and retrolingual dimensions during drug-induced sedation compared with wakefulness to assess mechanistic relationships in response to UAS.Patients with an implanted stimulator underwent nasal video endoscopy while awake and/or during drug-induced sedation in the supine position. The cross-sectional area, anterior–posterior and lateral dimensions of the retropalatal and retrolingual regions were measured during baseline and stimulation.15 patients underwent endoscopy while awake and 12 underwent drug-induced sedation endoscopy. Increased levels of stimulation were associated with increased area of both the retropalatal and retrolingual regions. During wakefulness, a therapeutic level of stimulation increased the retropalatal area by 56.4% (p=0.002) and retrolingual area by 184.1% (p=0.006). During stimulation, the retropalatal area enlarged in the anterior–posterior dimension while retrolingual area enlarged in both anterior–posterior and lateral dimensions. During drug-induced sedation endoscopy, the same stimulation increased the retropalatal area by 180.0% (p=0.002) and retrolingual area by 130.1% (p=0.008). Therapy responders had larger retropalatal enlargement with stimulation than nonresponders.UAS increases both the retropalatal and retrolingual areas. This multilevel enlargement may explain reductions of the apnoea–hypopnoea index in selected patients receiving this therapy.

THE COMPARISON OF CONFIGURATION, DEGREE AND SITES OF OBSTRUCTION IN PATIENTS WITH SLEEP DISORDERED BREATHING: EXAMINATION USING DRUG-INDUCED SLEEP ENDOSCOPY, MUELLER MANEUVER AND POLYSOMNOGRAPHY

2020 ◽  
pp. 54-57
Author(s):  
NIKEN AGENG RIZKI ◽  
SUSYANA TAMIN ◽  
FAUZIAH FARDIZZA ◽  
RETNO S. WARDANI ◽  
ARIEF MARSABAN ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Laryngopharyngeal Reflux ◽  
Nasal Congestion ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Mueller Maneuver

Objective: The purpose of this study is to evaluate the location, configuration, and degree of differences in upper airway obstruction between the Mueller Maneuver (MM) and Drug-induced sleep endoscopy (DISE), thus acquiring a better diagnostic value for SDB patients. Methods: A cross-sectional and analytical descriptive study using retrospective secondary data to evaluate the location, configuration and degree of upper airway obstruction in SDB subjects using the Mueller Maneuver and DISE. Polysomnography (PSG) type 2 was used to determine the SDB degree. Results: Subjects with SDB non-Obstructive sleep apnea (OSA) and OSA show a multilevel obstruction with a different location and configuration due to the various risk factors, such as nasal congestion, laryngopharyngeal reflux, obesity and menopause. Conclusion: Statistical differences in upper airway obstruction configuration between MM and DISE were found in the level of the velum (p=0,036), oropharynx (p<0,001) and epiglottis (p=0,036) and were also found in the obstruction degree of the velum, oropharynx, tongue base and epiglottis with p=0,002; p<0,001; p<0,001 and p<0,001. No statistical difference was found on the lowest oxygen saturation between PSG and DISE (p=0,055).

Computer-Assisted Quantitative Analysis of Drug-Induced Sleep Endoscopy for Obstructive Sleep Apnea/Hypopnea Syndrome

2020 ◽  
Vol 163 (6) ◽  
pp. 1274-1280
Author(s):  
Chi-Chih Lai ◽  
Pei-Wen Lin ◽  
Hsin-Ching Lin ◽  
Michael Friedman ◽  
Anna M. Salapatas ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Quantitative Analysis ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Computer Assisted ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome ◽  
Anterior Posterior

Objectives To use computer-assisted quantitative measurements of upper airway changes during drug-induced sleep endoscopy (DISE) and to correlate these parameters with disease severities and physiologic changes in patients with obstructive sleep apnea/hypopnea syndrome (OSA). Design A retrospective study. Setting Tertiary academic medical center. Patients and Methods A total of 170 patients who failed continuous positive airway pressure therapy and then underwent upper airway surgery were enrolled. All patients received polysomnography and DISE preoperatively. We used ImageJ 1.48v to obtain maximal and minimal measurements, including cross-sectional areas and anterior-posterior and lateral diameters at 4 anatomic levels (retropalatal, oropharyngeal, retroglossal, and retroepiglottic) under DISE, and then computed the percentage changes. We analyzed the clinical values of DISE changes by computer-assisted analysis in patients with OSA and any correlations between these changes and polysomnography parameters. Results The percentage changes of upper airway showed significant collapses at all 4 anatomic levels (all P < .0001). We also found that the changes at retropalatal levels were significantly greater and that retroglossal levels were significantly smaller, while the changes of anterior-posterior diameters at retroglossal levels showed a significant positive association with apnea-hypopnea index and desaturation index. However, there were no statistically significant correlations between upper airway changes and obesity. Conclusion Computer-assisted quantitative analysis could evaluate upper airway changes of OSA in an objective way and may help identify the sites of obstruction during DISE more accurately. Upper airway showed multilevel collapse with independent significant changes in patients with OSA, with the retropalatal and retroglossal levels playing important roles in particular.

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