Utility of sleep nasendoscopy versus microlaryngotracheobronchoscopy in the diagnosis of paediatric upper airway obstruction

Objective To describe the utility of sleep nasendoscopy in determining the level of upper airway obstruction compared to microlaryngotracheobronchoscopy. Methods A retrospective observational study was conducted at a tertiary level paediatric hospital. Patients clinically diagnosed with upper airway obstruction warranting surgical intervention (i.e. with obstructive sleep apnoea or laryngomalacia) were included. These patients underwent sleep nasendoscopy in the anaesthetic room; microlaryngotracheobronchoscopy was subsequently performed and findings were compared. Results Twenty-seven patients were included in the study. Sleep nasendoscopy was able to induce stridor or stertor, and to detect obstruction at the level of palate and pharynx, including tongue base collapse, that was not observed with microlaryngotracheobronchoscopy. Only 47 per cent of patients who had prolapse or indrawing of arytenoids on sleep nasendoscopy had similar findings on microlaryngotracheobronchoscopy. However, microlaryngotracheobronchoscopy was better in diagnosing shortened aryepiglottic folds. Conclusion This study demonstrates the utility of sleep nasendoscopy in determining the level and severity of obstruction by mimicking physiological sleep dynamics of the upper airway.

Sleep nasendoscopy

This chapter discusses Croft’s paper on sleep nasendoscopy including the design of the study (outcome measures, results, conclusions, and a critique).

Assessment of obstruction level and selection of patients for obstructive sleep apnoea surgery: an evidence-based approach

Introduction:Obstructive sleep apnoea has long been recognised as a clinical syndrome; however, high quality evidence on the effects of surgery for this condition is still missing. Despite this, a consensus seems to be evolving, albeit based on limited evidence, that surgery should be offered as a second line treatment to suitable patients with obstructive sleep apnoea.Aims:This article aims to assess the different methods of investigating upper airway obstruction in patients with obstructive sleep apnoea, in respect to these methods' relevance to surgical treatment, via a systematic review of the literature.Methods:The Cochrane Controlled Trials Register, Medline and EMBASE were searched from 1966 onwards. The search was performed in August 2008. A total of 2001 citations were retrieved.Results and conclusion:There is not yet a generally accepted way to assess surgical candidacy based on the level of obstruction. Better organised clinical studies with well defined endpoints are needed. In the meanwhile, it appears that sleep nasendoscopy, acoustic reflectometry and pressure catheters can all provide useful information, and their use may be decided upon based on the experience and resources available in individual departments.