scholarly journals A systematic review of anaesthetic agents used in Drug Induced Sedation Endoscopy (DISE) and a description of a new DISE technique

2021 ◽  
Author(s):  
Oliver Sanders ◽  
Bhik Kotecha ◽  
Vik Veer
Keyword(s):  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Limited Information ◽  
Drug Induced ◽  
Anaesthetic Agents ◽  
Industry Standard ◽  
Airway Collapse ◽  
Upper Airway Collapse ◽  
Obstructive Sleep

AbstractObjectivesDrug induced sleep endoscopy (DISE) is a standardly used investigation for surgical planning in obstructive sleep apnoea management once conservative treatments have proven inadequate. There are a variety of anaesthetic agents used to obtain sedation necessary for DISE. These agents may have different effect on the upper airway and other parameters important in the diagnosis of the site of collapse during sleep. We aimed to review the commonly agents and evaluate the significance of their impact on the the diagnosis.MethodsA search was conducted through PubMed looking for studies on commonly used anaesthetic agents and their effect on the upper airway and cardiopulmonary parameters. Results: Of the 109 studies yielded by the search, 19 were deemed relevant to the review and met all inclusion criteria. The agents reviewed were: propofol, dexmedetomidine, remifentanil, isoflurane, sevoflurane, midazolam and topical lidocaine. A meta-analysis was not conducted due to the limited number of relevant studies and the heterogeneity of outcomes measured. All agents examined gave some element of airway collapse and impact on cardiopulmonary measures. Most of these effects were shown to be dose-dependent. Of the agents considered dexmedetomidine and propofol gave the most consistently reliable and physiologically safe representations of upper airway collapse seen in OSA patients.ConclusionThere is limited information and no industry standard for the sedative regimen used for DISE. Of the agents reviewed those that caused least cardiopulmonary instability, respiratory depression and exaggerated upper airway collapse were deemed the most appropriate for DISE. The agent that best meet these criteria is dexmedetomidine followed by propofol.

scholarly journals Characteristics of Obstructive Sleep Apnea Patients With a Low Body Mass Index: Emphasis on the Obstruction Site Determined by Drug-Induced Sleep Endoscopy

2020 ◽  
Vol 13 (4) ◽  
pp. 415-421 ◽  
Author(s):  
Hyun-Jae Woo ◽  
Jae Hyun Lim ◽  
Jae-Cheul Ahn ◽  
Yu Jin Lee ◽  
Dong-Young Kim ◽  
...  
Keyword(s):  
Upper Airway ◽  
Lateral Position ◽  
Normal Weight ◽  
Tongue Base ◽  
Drug Induced ◽  
Airway Collapse ◽  
Upper Airway Collapse ◽  
Obstructive Sleep ◽  
Low Body Mass Index ◽  
Low Bmi

Objectives. This study aimed to elucidate the patterns of upper airway collapse in obstructive sleep apnea (OSA) patients with a low body mass index (BMI).Methods. We designed and conducted a retrospective cohort study. Consecutive patients diagnosed with OSA who underwent drug-induced sleep endoscopy (DISE) were included. Patients were classified into four groups according to their BMI. Age, sex, and polysomnography data were investigated. The patterns of upper airway collapse were characterized by the structures involved (soft palate, tongue base, lateral pharyngeal wall, and epiglottis). We compared the patterns of upper airway collapse in the supine and lateral decubitus position among the four BMI groups using the chi-square test and multivariate binary logistic regression analysis.Results. A total of 627 patients (male, 517; mean age, 47.6±12.8 years) were included, consisting of 45, 79, 151, and 352 patients who were underweight or lower normal-weight (defined as the low BMI group), upper normal-weight, overweight, and obese, respectively. Severity indicators of OSA, such as the overall apnea-hypopnea index and duration of SaO2 below 90%, were significantly lower in patients with a low BMI than in obese patients, while their average oxygen saturation was significantly higher. The most common obstruction site in the supine position was the tongue base in patients with a low BMI (100%), whereas this obstruction site was significantly less common in obese patients (54.8%). Tongue base obstruction was mostly relieved in the lateral position, with no discernible obstruction in 86.7% of the low BMI patients.Conclusion. Airway obstruction in OSA patients with a low BMI is mostly due to tongue base obstruction, which improves in the lateral position. These characteristics should be kept in mind when considering treatment options for this subgroup of OSA patients.

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 Effect of radiofrequency vs other surgeries in the management of obstructive sleep apnoea

2019 ◽  
Vol 5 (4) ◽  
pp. 893
Author(s):  
Atul M. Bage ◽  
Lakshman Bhaskar Muthuvel ◽  
Pradheep Kalatharan
Keyword(s):  
Upper Airway ◽  
Cost Effective ◽  
Sleep Apnoea ◽  
Age Group ◽  
Voice Change ◽  
Radiofrequency Surgery ◽  
Airway Collapse ◽  
Upper Airway Collapse ◽  
Post Operative Pain ◽  
Obstructive Sleep

<p class="abstract"><strong>Background:</strong> Snoring is an important social problem seen in both men and women. Snoring occurs as a result of soft tissue vibration caused by a partial upper airway collapse during sleep. The aim of the study was to analyse the morbidity and efficacy of radiofrequency thermal ablation of upper airway in patients suffering from OSA.</p><p class="abstract"><strong>Methods:</strong> In the Department of ENT, Pondicherry, 40 patients between the age group of 20 to 60 years who were diagnosed to have OSA were operated according to the site of obstruction including RFVTR. Various parameters including ESS, partner scores, post-op pain, bleeding, pharyngeal dryness voice change were measured accordingly on the 1st day, 45th day, 90th day and 180th day postoperatively for the efficacy of treatment and also for assessing the morbidity of treatment provided.  </p><p class="abstract"><strong>Results:</strong> There is a statistically significant reduction in ESS scores and partner scores between pre-operative period and post operatively on the 45th day, 90th day and 180th day. Post-operative pain assessment also showed that patients who underwent RFVTR had lesser pain when compared to other surgeries like zetaplasty, LAUP, etc.</p><p class="abstract"><strong>Conclusions:</strong> Radiofrequency surgery should be considered as the treatment of choice for mild OSA and hypopneic snorers. The important advantage of these procedures is technically simple and minimally invasive. RFTA of the soft palate leaves the mucosa intact contrary to LAUP, hence the pain comparably less. Relatively cost effective when compared to LASER and Coblator.</p>

scholarly journals Much Ado about Sleep: Current Concepts on Mechanisms and Predisposition to Pediatric Obstructive Sleep Apnea

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1032
Author(s):  
Ashley L. Saint-Fleur ◽  
Alexa Christophides ◽  
Prabhavathi Gummalla ◽  
Catherine Kier
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Biomechanical Properties ◽  
Primary Role ◽  
Airway Narrowing ◽  
Airway Collapse ◽  
Upper Airway Collapse ◽  
Obstructive Sleep ◽  
Review Current

Obstructive Sleep Apnea (OSA) is a form of sleep-disordered breathing characterized by upper airway collapse during sleep resulting in recurring arousals and desaturations. However, many aspects of this syndrome in children remain unclear. Understanding underlying pathogenic mechanisms of OSA is critical for the development of therapeutic strategies. In this article, we review current concepts surrounding the mechanism, pathogenesis, and predisposing factors of pediatric OSA. Specifically, we discuss the biomechanical properties of the upper airway that contribute to its primary role in OSA pathogenesis and examine the anatomical and neuromuscular factors that predispose to upper airway narrowing and collapsibility.

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