scholarly journals Comparison of Findings between Clinical Examinations and Drug-Induced Sleep Endoscopy in Patients with Obstructive Sleep Apnea Syndrome

2020 ◽  
Vol 17 (17) ◽  
pp. 6041
Author(s):  
Huan-Yu Lin ◽  
Yi-Chih Lin ◽  
Ying-Shuo Hsu ◽  
Liang-Chun Shih ◽  
Tyler Nelson ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Staging System ◽  
Tongue Base ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Physical Examinations

The Velum, Oropharynx, Tongue base and Epiglottis (VOTE) classification on drug-induced sleep endoscopy (DISE) is used widely for obstructive sleep apnea (OSA) syndrome, though research into comparative physical examinations with VOTE on DISE is still limited. The aim of this study was to evaluate the relationship between the findings of physical examinations and DISE in patients with OSA. Fifty-five patients with OSA were enrolled in this retrospective study. All of the patients received clinical explorations including a Brodsky classification, a modified Mallampati score (MMS), a modified Friedman’s staging system, and a Muller’s test. Drug-induced sleep endoscopy was further evaluated in the operating room. There were significant relationships between Brodsky classification, modified Friedman’s staging system, Muller’s test and oropharynx collapse during DISE (p < 0.05). Brodsky classification, MMS, modified Friedman’s staging system and retropalatal lateral-to-lateral (L–L) collapse of Muller’s test were significantly correlated with VOTE count (p < 0.05). The concordance between VOTE under DISE and Brodsky classification or modified Friedman’s staging system was moderate. In contrast, the concordance between VOTE under DISE and MMS or Muller’s test was slight. The study revealed that Brodsky classification and Friedman staging had a significant relationship with DISE on the velum and oropharynx, but the level of tongue base is uncertain between DISE and MMS. Correlation of awake evaluation of tongue base is still not correlated to the DISE findings. Pre-treatment evaluation of DISE is still warranted.

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.

Drug-Induced Sleep Endoscopy with Target-Controlled Infusion Using Propofol in the Management of Patients with Obstructive Sleep Apnea

2018 ◽  
Vol 69 (6) ◽  
pp. 1431-1434
Author(s):  
Dragos Cristian Stefanescu ◽  
Razvan Hainarosie ◽  
Viorel Zainea
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Mandibular Advancement ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Multicenter Studies ◽  
Drug Induced Sleep Endoscopy ◽  
Target Controlled Infusion ◽  
Obstructive Sleep

Although it seems to be an exhausted subject at first glance, the therapeutic approach in obstructive sleep apnea syndrome (O.S.A.S.) is still an open subject. The continuous positive airway pressure (C.P.A.P.) represents the gold standard of therapy in O.S.A.S. However, this therapeutic process with C.P.A.P. has a low rate of compliancy, over 50% of patients quit in the first year of use. Implicitly, surgical solutions or mandibular advancement devices remain an alternative for many of these patients. High costs, complexity and risks associated with surgery have led to the identification of more accurate methods for topographic and functional diagnosis in O.S.A.S. Drug-induced sleep endoscopy (D.I.S.E.) with target-controlled infusion (T.C.I.) using propofol in the management of patients with obstructive sleep apnea is a relatively recently introduced method in Romania. The present paper describes our experience with D.I.S.E for selected patients, who have undergone surgery on the upper airway for O.S.A.S. The D.I.S.E method has led to the modification of the initial surgical plan in over 60% of patients with multi-level obstruction. Under these conditions, the surgical success rate in patients of the study increased to 80% at 6 months. Considering the specific endowment of each tertiary sleep center, the presence or absence of an operator block and the anesthetist�s experience with target-controlled (T.C.I.) infusion using propofol, more extensive and multicenter studies are needed for standardization of D.I.S.E.

Drug-Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea

2020 ◽  
pp. 019459982094766
Author(s):  
Diogo Raposo ◽  
Marco Menezes ◽  
João Rito ◽  
Mafalda Trindade-Soares ◽  
Cristina Adónis ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Linear Regression ◽  
Tongue Base ◽  
Care Hospital ◽  
Simple Linear Regression ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

Objective To describe drug-induced sleep endoscopy (DISE) findings in children with obstructive sleep apnea and to differentiate them between surgically naïve children and children who had adenotonsillectomy performed. Study Design Retrospective case series with chart review. Setting Secondary care hospital. Subjects and Methods A cohort of 56 children with the diagnosis of obstructive sleep apnea was submitted to DISE and subsequent upper airway surgery: 23 were surgically naïve, and 33 had persistent obstructive sleep apnea after adenotonsillectomy. Comparisons between groups were calculated with chi-square test and Student’s t test. Simple linear regression was used to model polysomnographic indices. Results In surgically naïve children, the most common sites of obstruction were the adenoids (78.2%) and the lateral pharyngeal walls/tonsils (82.6%). In children with persistent obstructive sleep apnea after adenotonsillectomy, the most common sites of obstruction were the adenoids (54.5%), followed by the supraglottis (48.5%) and the tongue base (45.5%). No correlation was found between obstructive apnea-hypopnea index and DISE findings. Simple linear regression revealed that the degree of obstruction at the tongue base (β = −0.73; 95% CI, −1.22 to −0.25; P = .004) and the presence of multilevel obstruction (β = −1.75; 95% CI, −3.20 to −0.30; P = .02) predicted saturation nadir in children with persistent obstructive sleep apnea after adenotonsillectomy. Conclusion DISE findings differed between surgically naïve children and children with persistent obstructive sleep apnea after adenotonsillectomy. Increased obstruction at the level of the tongue base and the presence of multilevel obstruction predicted a lower saturation nadir in children with persistent obstructive sleep apnea after adenotonsillectomy.

Systematic Review of Drug-Induced Sleep Endoscopy Scoring Systems

2017 ◽  
Vol 158 (2) ◽  
pp. 240-248 ◽  
Author(s):  
Janine M. Amos ◽  
Megan L. Durr ◽  
Heather C. Nardone ◽  
Cristina M. Baldassari ◽  
Angela Duggins ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Scoring System ◽  
Scoring Systems ◽  
Tongue Base ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

Objective To systematically review the scoring systems used to report findings during drug-induced sleep endoscopy (DISE) for adults and children with obstructive sleep apnea. Data Sources PubMed, CINAHL, EBM Reviews, Embase, and Scopus databases. Review Methods This is a systematic review of all indexed years of publications referring to scoring of DISE for children and adults with obstructive sleep apnea. The type of DISE scoring system utilized was the primary outcome. PRISMA guidelines were followed to carry out this review; articles were independently reviewed by 2 investigators. All pediatric and adult studies that utilized ≥1 DISE grading systems were included. Results Of 492 identified abstracts, 44 articles (combined population, N = 5784) were ultimately included; 6 reported on children, 35 on adults, and 1 on children and adults. Twenty-one reporting methods were used in these studies, with the most common being the VOTE system (velum, oropharynx, tongue base, and epiglottis; 38.6%) and the Pringle and Croft classification (15.9%). The sites of obstruction most commonly included in a scoring system were the tongue base (62%), lateral pharynx/oropharynx (57%), palate (57%), epiglottis/supraglottis (38%), and hypopharynx (38%). Less commonly included sites were the larynx (29%), velum (23%), nose (23%), tongue (14%), adenoids (10%), and nasopharynx (10%). Conclusion There is no consensus regarding which scoring system should be utilized to report findings during DISE. The VOTE system and the Pringle and Croft classification were the most frequent scoring systems reported for patients undergoing DISE. Standardization of the reporting of DISE findings would improve comparability among studies.

scholarly journals Non-acid reflux and sleep apnea: the importance of drug induced sleep endoscopy

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Carlos O’Connor-Reina ◽  
Jose Maria Ignacio Garcia ◽  
Peter Baptista ◽  
Maria Teresa Garcia-Iriarte ◽  
Carlos Casado Alba ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Reflux Disease ◽  
Sleep Apnea Syndrome ◽  
Acid Reflux ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Abstract Background We present the first case of a patient with obstructive sleep apnea syndrome (OSA), where drug induced sleep endoscopy was helpful to suspect a non-acid reflux disease and showed an improvement in a swollen epiglottis after treatment. Patient ameliorated significantly his disease only with medical therapy. Case presentation A 54-year-old man without significant anatomical findings with obstructive sleep apnea syndrome and non-acid gastroesophageal reflux disease (GERD) disease whose Apnea- hypopnea index (AHI) was significantly reduced with the intake of 500 mg of sodium alginate twice a day for 6 months. Conventional digestive tests such as esophagoscopy and simple- and double-channel 24-h pH-metry suggested mild GERD. Conventional proton-pump inhibitor treatment with pantoprazole (40 mg daily) was started without any improvement in his sleep. Multichannel intraluminal 24-h impedanciometry indicated the presence of severe pathological GER of gaseous origin. The patient’s AHI decreased from 25.3 at baseline to 8 after treatment with sodium alginate. A drug-induced sleep endoscopy study showed the changes before and after this treatment and was helpful for the diagnosis. Conclusions Thus, medical treatment can be a therapeutic option in some patients with OSA. Multichannel 24-h impedanciometry should be performed when nonacid GERD is suspected.

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