scholarly journals Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy

2019 ◽  
Vol 57 (9) ◽  
pp. 1406-1413
Author(s):  
Valeria Bisogni ◽  
Giuseppe Maiolino ◽  
Giulio Ceolotto ◽  
Martino F. Pengo ◽  
Rosario Marchese Ragona ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Plasma Catecholamines ◽  
Sleep Apnoea ◽  
Sleep Endoscopy ◽  
Upper Airways ◽  
Drug Induced ◽  
Chromatography Method ◽  
Plasma Aldosterone Concentration ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

Abstract Background Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Methods Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. Results and conclusions The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA.

scholarly journals Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Jaroslava Hybášková ◽  
Ondřej Jor ◽  
Vilém Novák ◽  
Karol Zeleník ◽  
Petr Matoušek ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Treatment Concept ◽  
Sleep Endoscopy ◽  
Upper Airways ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n=17, 33.3%), followed by palatal and oropharyngeal collapse (n=12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

scholarly journals Drug-induced sleep endoscopy compared with systematic adenotonsillectomy in the management of obstructive sleep apnoea in children: a systematic review and meta-analysis protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028242 ◽  
Author(s):  
Anne-Sophie Prévost ◽  
Mathieu Hylands ◽  
Mireille Gervais ◽  
Jean-Paul Praud ◽  
Marie-Claude Battista ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Data Extraction ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Published Data ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

IntroductionObstructive sleep apnoea affects up to 6% of children worldwide. Although current guidelines recommend systematic tonsillectomy and adenoidectomy, many children do not benefit from these interventions. Drug-induced sleep endoscopy (DISE) allows the dynamic evaluation of patients’ airways to identify the specific anatomic sites of obstruction. This intervention can potentially guide subsequent invasive procedures to optimise outcomes and minimise the number of children exposed to unnecessary operations.Methods and analysisWe will identify randomised controlled trials and controlled observational studies comparing DISE-directed interventions to systematic tonsillectomy and adenoidectomy in paediatric populations. We will search MEDLINE, EMBASE, CINAHL, CENTRAL as well as clinical trial registries and conference proceedings (initial electronic search date 9 October 2018). Screening, data extraction and risk of bias assessments will be performed in duplicate by independent reviewers. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the overall quality of evidence and present our results.Ethics and disseminationEthics approval is not required for this systematic review of published data. This review will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will present our findings at otorhinolaryngology conferences and publish a report in a peer-reviewed journal.PROSPERO registration numberCRD42018085370.

Obstructive sleep apnoea as a late complication after tracheostomy

2019 ◽  
Vol 133 (7) ◽  
pp. 632-635
Author(s):  
D Đanić ◽  
N Mrzljak Vučinić ◽  
A Đanić Hadžibegović
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Vocal Folds ◽  
Sleep Apnoea ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Pressure Therapy ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Cervical Trachea

AbstractBackgroundObstructive sleep apnoea occurs consequent to partial or complete upper airway obstruction, caused mostly by the collapse of upper airway musculature. Drug-induced sleep endoscopy represents the ‘gold standard’ in identifying the obstruction site, from the palatal level to laryngeal entry. Breathing impairment in sleep caused by the collapse of cervical trachea after previous tracheostomy has not yet been described in the literature.MethodsThis report presents two patients with severe obstructive sleep apnoea, in whom pre-operative drug-induced sleep endoscopy revealed upper airway and cervical trachea collapse at the level of previous tracheostomy.ResultsThe female patient was successfully treated with resection of hypertrophic tissue of the tongue base via lateral pharyngectomy, and resection of the collapsed segment of the trachea with primary reconstruction of the trachea by end-to-end anastomosis. The male patient was recommended continuous positive airway pressure therapy because of serious co-morbidities and high operative risk.ConclusionDrug-induced sleep endoscopy should always be used for visualisation of anatomical structures below the vocal folds in patients with a history of cervical trachea surgery. These two cases demonstrate the importance of drug-induced sleep endoscopy in planning conservative and surgical treatments, contributing significantly to operative success.

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