Drug-Induced Sleep Endoscopy Performed in the Endoscopy Suite: A Resource Utilization Analysis

2020 ◽  
Vol 162 (3) ◽  
pp. 386-391
Author(s):  
Shabnam Ghazizadeh ◽  
Kyasha Moore ◽  
Kianusch Kiai ◽  
Abie H. Mendelsohn
Keyword(s):  
Resource Utilization ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Postoperative Recovery ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Surgical Time ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Patient Groups

Objectives To analyze the resource utilization of performing drug-induced sleep endoscopy (DISE) procedures in an endoscopy suite (ES) setting as compared with the operating room (OR). Study Design A retrospective review of DISE procedures performed by a single attending surgeon from 2016 to 2018. Setting Tertiary hospital. Subjects and Methods All patients undergoing sleep endoscopy without concurrent surgical procedures were included. No exclusion criteria were incorporated. Analysis assessed for differences in procedure-related expenditures, patient characteristics, anesthesia and surgeon time, and access to care. Results A total of 87 sleep endoscopies were included: 65 (74.7%) performed in the ES and 22 (25.3%) in the OR. Patient groups were similar in age and apnea-hypopnea index severity ( P > .05). Patient body mass index was significantly higher for the ES group ( P = .03). Total facility time, postoperative recovery time, anesthesia care time, and time in the surgical room were significantly decreased in the ES setting ( P < .01). Surgical time was similar between the groups ( P > .05). For ES procedures, total cost was reduced by 74% ( P < .01). DISE in the ES resulted in a mean $5080 less in health system charges versus the OR group ( P < .01). There were no treatment-related complications in either setting. Conclusion The resource utilization profile of performing DISE can be significantly improved by transferring these procedures from the OR to the ES setting.

Robotic Modification of Epiglottis Trimming in the Treatment of Obstructive Sleep Apnea

2021 ◽  
pp. 019459982110646
Author(s):  
Mehmet Ali Babademez ◽  
Fatih Gul ◽  
Kadir Sinasi Bulut ◽  
Mecit Sancak ◽  
Saliha Kusoglu Atalay
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tertiary Hospital ◽  
Apnea Hypopnea Index ◽  
Complete Relief ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Significant Difference

Objective With the widespread use of drug-induced sleep endoscopy, it has been suggested that epiglottis pathologies are present at high rates in patients with sleep apnea. The aim of our study was to evaluate the efficacy of trimming the curled-inward epiglottis as an updated surgical technique in patients with omega epiglottis. Study Design Retrospective study. Setting Tertiary hospital. Methods Among the 283 patients with epiglottis pathology, 21 with isolated omega-shaped epiglottis (age, 33-53 years) fulfilled the inclusion criteria between May 2016 and April 2019. Drug-induced sleep endoscopy was used to detect epiglottic collapse compressed by the lateral parts during inspiration. An epiglottoplasty technique was applied as single-level sleep surgery in patients with an isolated omega-shaped epiglottis. The medical data were also reviewed. Results The mean pre- and postoperative total apnea-hypopnea index (AHI) scores were 27.89 and 10.58, respectively, and this difference was statistically significant ( P < .001). There was a statistically significant difference between the pre- and postoperative supine AHI scores (27.02 vs 10.48, P < .001). Surgical success, defined as AHI <20 and a decrease in AHI by 50%, was documented in 85.71% of patients (18/21), and 12 patients found complete relief from obstructive sleep apnea symptoms (AHI <5); the cure rate was 38.09% (8/21). Conclusion Trimming the curled-inward epiglottis may represent an excellent option for epiglottis surgery in patients with obstructive sleep apnea by being less invasive than techniques currently in use.

Diagnosis of Retrolingual Obstruction during Drug-Induced Sleep Endoscopy versus Polysomnography with Nasopharyngeal Tube in Patients with Obstructive Sleep Apnea

2021 ◽  
pp. 000348942110059
Author(s):  
Jian Qiao ◽  
Jie Qin ◽  
Dengxiang Xing ◽  
Shuhua Li ◽  
Dahai Wu
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lateral Wall ◽  
Patient Characteristics ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Cross Sectional ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

Objective: To compare the retrolingual obstruction during drug-induced sleep endoscopy (DISE) with the retrolingual obstruction during polysomnography with nasopharyngeal tube (NPT-PSG). Methods: A cross-sectional study of 77 consecutive patients with moderate and severe obstructive sleep apnea (OSA) was conducted. After 15 patients were excluded from the study for not completing DISE or NPT-PSG successfully, 62 patients were included in this study. Retrolingual sites of obstruction grade 2 determined by DISE according to the VOTE (velum, oropharynx lateral wall, tongue base, and epiglottis) classification were considered as retrolingual obstruction, while apnea-hypopnea index (AHI) ≥ 15 events/hour determined by NPT-PSG was considered as retrolingual obstruction. The extent of agreement between DISE and NPT-PSG findings was evaluated using unweighted Cohen’s kappa test. Results: The 62 study participants (11 moderate OSA, 51 severe OSA) had a mean (SD) age of 39.8 (9.9) years, and 58 (94%) were men. No statistically significant differences between included and excluded patients were observed in patient characteristics. The extent of agreement in retrolingual obstruction between DISE and NPT-PSG was 80.6% (Cohen k = 0.612; 95% CI, 0.415-0.807). Conclusion: Retrolingual obstruction requiring treatment showed good agreement between DISE and NPT-PSG, suggesting that NPT-PSG may also be a reliable method to assess the retrolingual obstruction.

Drug-Induced Sleep Endoscopy in Children With Positional Obstructive Sleep Apnea

2020 ◽  
pp. 019459982094101
Author(s):  
Erin M. Kirkham ◽  
Jonathan B. Melendez ◽  
Karen Hoi ◽  
Ronald D. Chervin
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lateral Wall ◽  
Tongue Base ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Positional Obstructive Sleep Apnea ◽  
Obstructive Sleep

Objective Positional obstructive sleep apnea (POSA)—defined as obstructive sleep apnea twice as severe supine than nonsupine—may offer clues to the underlying pattern of upper airway collapse in children. We compared drug-induced sleep endoscopy (DISE) findings in children with and without POSA. We hypothesized that children with POSA would have significantly higher obstruction at the gravity-dependent palate and tongue base but not at the adenoid, lateral wall, or supraglottis. Study Design Retrospective case series. Setting Tertiary pediatric hospital. Subjects and Methods We included children aged 1 to 12 years with obstructive sleep apnea diagnosed by polysomnography who underwent DISE from July 2014 to February 2019. Scores were dichotomized as ≥50% obstruction (Chan-Parikh 2 or 3) vs <50% obstruction (Chan-Parikh 0 or 1). Results Of 99 children included, 32 (32%) had POSA and 67 (68%) did not. Children with POSA did not differ from children without POSA in age, overall apnea-hypopnea index, sex, race, syndromic diagnoses, obesity, or history of adenotonsillectomy. In logistic regression models, odds of ≥50% obstruction were significantly higher at the tongue base (odds ratio, 2.77; 95% CI, 1.04-7.39) after adjustment for age, sex, obesity, previous adenotonsillectomy, and syndrome. No difference was noted at the adenoid, velum, lateral wall, or supraglottis. Conclusion POSA was associated with higher odds of obstruction on DISE at the tongue base but not at other levels.

Airway Obstruction during Drug-Induced Sleep Endoscopy Correlates with Apnea-Hypopnea Index and Oxygen Nadir in Children

2016 ◽  
Vol 155 (4) ◽  
pp. 676-680 ◽  
Author(s):  
John P. Dahl ◽  
Craig Miller ◽  
Patricia L. Purcell ◽  
David A. Zopf ◽  
Kaalan Johnson ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy

Outcomes of Hypoglossal Nerve Upper Airway Stimulation among Patients with Isolated Retropalatal Collapse

2019 ◽  
Vol 160 (6) ◽  
pp. 1124-1129 ◽  
Author(s):  
Ahmad F. Mahmoud ◽  
Erica R. Thaler
Keyword(s):  
Medical Center ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Inclusion Criteria ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Upper Airway Stimulation ◽  
Oxyhemoglobin Saturation ◽  
Drug Induced Sleep Endoscopy ◽  
Industry Standard

Objective To examine whether patients with isolated retropalatal collapse perform as well as others following implantation with an upper airway stimulation (UAS) device. Study Design Retrospective review. Setting Single-institution tertiary academic care medical center. Subjects and Methods Following drug-induced sleep endoscopy, subjects who met inclusion criteria for implantation with a UAS device received an implant per industry standard. Subjects with isolated retropalatal collapse were compared with those having other patterns of collapse. Outcome measures included apnea-hypopnea index (AHI) and nadir oxyhemoglobin saturation (NOS). Results Ninety-one patients were implanted during the duration of the study, and 82 met inclusion criteria for analysis. Twenty-five had isolated retropalatal collapse, while the remaining 57 had other patterns of collapse on drug-induced sleep endoscopy. For all patients, mean preoperative AHI and NOS were 38.7 (95% CI, 35.0-42.4) and 78% (95% CI, 75%-80%), respectively; these improved postoperatively to 4.5 (95% CI, 2.3-6.6) and 91% (95% CI, 91%-92%). There was no significant preoperative difference between groups with regard to demographics, AHI, or NOS. Group comparison showed postoperative AHI to be 5.7 (95% CI, 0.57-10.8) for patients with isolated retropalatal collapse and 3.9 (95% CI, 1.7-6.1) for other patients ( P = .888). Postoperative NOS was 92% (95% CI, 90%-94%) among patients with isolated retropalatal collapse and 91% (95% CI, 90%-92%) for others ( P = .402). Conclusions All patients showed significant improvement following implantation with UAS. Patients with isolated retropalatal collapse showed similar improvement to other types of collapse with regard to AHI and NOS.

scholarly journals Drug-induced Sleep Endoscopy: Are there Predictors for Failure of Oral Appliance Treatment?

2021 ◽  
Author(s):  
Christianne C.A.F.M. Veugen ◽  
Rineke M.C. Sanders ◽  
Robert J. Stokroos ◽  
Marcel P. Copper
Keyword(s):  
Oral Appliance ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Evaluation Tool ◽  
Drug Induced ◽  
Failure Group ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Jaw Thrust Maneuver

Abstract Introduction In the literature, evidence is lacking on the predictive value of drug-induced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] > 10 events/hour or < 50% reduction) and a group with OAT benefit (AHI <10 events/hour or > 50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI < 30 events/hour included 26 patients. In the OAT failure group, 74% had a negative jaw thrust maneuver. In the subgroup with an AHI < 30 events/hour, 76.9% had a negative jaw thrust maneuver. In the OAT benefit group, 25% had a negative jaw thrust maneuver (p < 0.001). Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT.

Outcomes of Drug-Induced Sleep Endoscopy–Directed Surgery for Pediatric Obstructive Sleep Apnea

2017 ◽  
Vol 158 (3) ◽  
pp. 559-565 ◽  
Author(s):  
Shan He ◽  
Nithin S. Peddireddy ◽  
David F. Smith ◽  
Angela L. Duggins ◽  
Christine Heubi ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Body Mass ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
White Race ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

Objectives To determine the effectiveness of pediatric drug-induced sleep endoscopy (DISE)–directed surgery for children with infant obstructive sleep apnea (OSA) or OSA after adenotonsillectomy. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods We included 56 children undergoing DISE from October 2013 to September 2015 who underwent subsequent surgery to address OSA. The primary outcome was successful response to DISE-directed surgery based on the postoperative obstructive Apnea-Hypopnea Index (oAHI). Wilcoxon matched-pairs signed-ranks tests were used to compare polysomnography variables before and after surgery, and regression was used to model response to surgery. Results We evaluated 56 patients with a mean age of 5.9 ± 5.5 years (range, 0.1-17.4) and mean body mass index of 21.2 ± 7.9 kg/m2 (percentile, 77 ± 30). The most commonly performed surgical procedures were adenoidectomy (48%, n = 27), supraglottoplasty (38%, n = 21), tonsillectomy (27%, n = 15), lingual tonsillectomy (13%, n = 7), nasal surgery (11%, n = 6), pharyngoplasty (7%, n = 4), and partial midline glossectomy (7%, n = 4). Mean oAHI improved from 14.9 ± 13.5 to 10.3 ± 16.2 events/hour, with 54% (30 of 56) of children with oAHI <5 and 16.1% (9 of 56) with oAHI <1. There was a significant improvement in oAHI ( P = .001) and saturation nadir ( P < .001) but not in time with end tidal carbon dioxide >50 mm Hg ( P = .14). Multivariable modeling, controlling for age, race, body mass index, sex, and baseline polysomnography variables, revealed that white race predicted success of DISE-directed surgery. Conclusion Fifty-four percent of children with infant OSA or persistent OSA after adenotonsillectomy had oAHI <5 events per hour after DISE-directed surgery. Only white race was predictive of oAHI <5 events per hour.

scholarly journals Palatine Tonsil Stenting of the Airway as Determined by Drug-Induced Sleep Endoscopy

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Habib G. Zalzal ◽  
Steven Coutras
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Apnea Hypopnea Index ◽  
Lateral Pharyngeal Wall ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Pharyngeal Wall ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

Objective. To demonstrate lateral pharyngeal wall collapse and increased apnea-hypopnea index in a child posttonsillectomy. Background. Some children have worsening of their sleep symptoms after tonsillectomy for obstructive sleep apnea. This case report demonstrates an open airway on drug-induced sleep endoscopy (DISE) in a child with tonsillar hypertrophy followed by more pronounced airway obstruction related to lateral pharyngeal wall collapse after tonsillectomy. Case Presentation. A 7-year-old boy presented with obstructive sleep apnea and underwent workup with DISE. Following adenotonsillectomy and subsequent lingual tonsillectomy with epiglottopexy, the patient’s sleep apnea symptoms and polysomnogram results worsened. Subsequent DISE showed a more narrowed oropharyngeal airway space as compared to his preoperative DISE. Discussion. Palatine tonsillar tissue may splint open the airway and prevent airway obstruction in a subset of pediatric patients. Further clinical studies are necessary to determine which children experience this phenomenon. Clinical examination using DISE can be useful in making clinical decisions prior to tonsillectomy.

scholarly journals Patterns of Upper Airway Obstruction on Drug-Induced Sleep Endoscopy in Patients with Sleep-Disordered Breathing with AHI <5

OTO Open ◽  
2017 ◽  
Vol 1 (3) ◽  
pp. 2473974X1772148
Author(s):  
Sam Spinowitz ◽  
Mimi Kim ◽  
Steven Y. Park
Keyword(s):  
Airway Obstruction ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Multiple Levels ◽  
Disordered Breathing

Objective To describe the patterns of upper airway obstruction in patients with sleep-disordered breathing with apnea-hypopnea index (AHI) <5 using drug-induced sleep endoscopy (DISE). Study Design Retrospective study. Setting Tertiary care center. Subjects and Methods Inclusion of patients with sleep-disordered breathing with AHI <5 on polysomnography who underwent DISE. Patients <18 years of age were excluded. DISE findings were reported with the VOTEL classification system: the level of collapse was described as occurring at the velum, oropharynx, tongue base, epiglottis, and the lingual tonsils. The degree of collapse was reported as complete, partial, or none. The pattern of the obstruction was described as anteroposterior, lateral, or concentric when applicable. Results A total of 54 patients with sleep-disordered breathing with AHI <5 underwent DISE. Ages ranged from 19 to 65 years. DISE was performed alone in 7% (n = 4) of patients and in conjunction with surgery in 93% (n = 50) of patients. The velum was the most frequent site of upper airway obstruction (85%, n = 46), followed by base of tongue (63%, n = 34), epiglottis (39%, n = 21), lingual tonsils (35%, n = 19), and oropharynx (31%, n = 17). Eighty-three percent (n = 45) of patients had multiple levels of upper airway obstruction, and 15% (n = 8) had a single level of upper airway obstruction. Conclusion Patients with sleep-disordered breathing with AHI <5 have significant upper airway obstruction as seen on DISE. DISE findings indicate that a majority of these patients have multiple levels of upper airway obstruction, which can lead to significant symptoms.

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