The Role of Drug-induced Sleep Endoscopy in Treatment (Surgical and Non-surgical) in Patients with Obstructive Sleep Apnea

Czech version

Authors: J. Hybášková ¹; O. Jor ²; V. Novák ³; P. Matoušek ¹; P. Komínek ¹
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku LF OU a FN Ostrava ¹; Klinika anesteziologie, resuscitace a intenzivní medicíny LF OU a FN Ostrava ²; Centrum pro poruchy spánku a bdění – spánková laboratoř, Oddělení dětské neurologie, FN Ostrava ³
Published in: Cesk Slov Neurol N 2017; 80/113(4): 428-433
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2017428

Overview

Aim:
Identifying the site of obstruction and the pattern of airway changes during sleep is essential to guide the treatment for obstructive sleep apnoea (OSA) in adults. The aim of the study was to evaluate whether drug-induced sleep endoscopy (DISE) helps to identify the site of obstruction in patients with OSA and whether DISE can find the reason for continuous positive airway pressure (CPAP) failure or intolerance.

Methods:
66 patients with OSA (8 women, 58 men) were enrolled for this prospective observational study and indicated for DISE in the period from August 2015 to September 2016. The sites of obstruction in the upper airways were identified. The indications for surgery according to otorhinolaryngology examination before DISE and after DISE were compared. In 11 patients with severe OSA and/ or previously failed CPAP treatment, DISE with simultaneous CPAP (continuous positive airway pressure) was performed.

Results:
The most frequent multilevel collapse pattern was a combination of palatal, oropharyngeal, and base of tongue collapse (33.3%). A pathology of larynx (epiglottis) was observed in 21/ 66 (31.8%) patients. After DISE the surgical plan was changed in 44/ 66 (66.7%) of all patients. A pathology of epiglottis as a reason for CPAP failure was observed in 3/ 11 (27.3%) patients.

Conclusion:
DISE helps to identify the site of obstruction of the upper airways in patients with OSA more accurately. The larynx plays an important role in OSA. Laryngeal obstruction can be a reason for intolerance of CPAP and failure of OSA surgery.

Key words:
drug-induced sleep endoscopy – obstructive sleep apnea – larynx – continuous positive airway pressure

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers

Chinese summary - 摘要

药物诱导睡眠内镜在阻塞性睡眠呼吸暂停患者治疗（手术和非手术）中的作用

目标：

识别阻塞部位和睡眠期间气道变化的模式对于指导成年人阻塞性睡眠呼吸暂停（OSA）的治疗是必不可少的。本研究的目的是评估药物诱导睡眠内镜（DISE）是否有助于确定OSA患者梗阻部位，以及DISE是否能够找到持续气道正压通气（CPAP）失败或不耐受的原因。

方法：

在2015年8月至2016年9月期间，66名OSA患者（8名女性，58名男性）参加了DISE的前瞻性观察研究，并确定了其上呼吸道梗阻部位。根据耳鼻咽喉科检查比较了DISE前、后的手术指征。在11例重度OSA和/或先前CPAP治疗失败的患者中，同时进行DISE和CPAP（持续气道正压通气）治疗。

结果：

最常见的多层面塌陷模式是腭部、口咽部和舌根塌陷的组合（33.3％）。在21/66（31.8％）的患者中观察到喉（会厌软骨）的病理异常。DISE治疗后，44/66（66.7％）的患者的手术计划被改变。会厌软骨病理异常导致3/11（27.3％）的患者CPAP治疗失败。

结论：

DISE有助于更准确地确定OSA患者上呼吸道梗阻部位。喉在OSA中起着重要的作用。喉阻塞可能是CPAP不耐和OSA手术失败的原因之一。

关键词：

药物诱导睡眠内镜 - 阻塞性睡眠呼吸暂停 - 喉 - 持续气道正压通气

Sources

1. Aktas O, Erdur O, Cirik AA, et al. The role of drug-induced sleep endoscopy in surgical planning for obstructive sleep apnea syndrome. European Archives of Oto-Rhino-Laryngology 2014;272(8):2039– 43. doi: 10.1007/ s00405-014-3162-8.

2. Campanini A, Canzi P, De Vito A, et al. Awake versus sleep endoscopy: personal experience in 250 OSAHS patiens. Acta Otorhinolaryngologica Italica 2010;30(2):73– 7.

3. Hybášková J, Babiarová V, Jor O, et al. Flexibilní endoskopie horních cest dýchacích v léky navozeném spánku. Otorinolaryng Foniat Prague 2016;1:30– 4.

4. Betka J, Klozar J, Kuchař M, et al. Léky navozená spánková endoskopie – cesta k lepším chirurgickým výsledkům při léčbě syndromu obstrukční spánkové apnoe, Cesk Slov Neurol N 2016;79/ 112(5):516– 20.

5. Cavaliere M, Russo F, Iemma M. Awake versus drug-induced sleep endoscopy: evaluation od airway obstruction in obstructive sleep apnea/ hypoponoea syndrome. Laryngoscope 2013;123(9):2315– 8.

6. Phang, KP, Rotenberg BW, Woodson BT. Advanced Surgical Techniques in Snoring and Obstructive SleepApnea. CA: Plural Pub 2013:43– 63.

7. De Corso E, Fiorita A, Rizzotto G, et al. The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnea syndrome: our personal experience. Acta Otorhinolaryngoloica Italica 2013;33(6):405– 13.

8. De Vito A, Liatas MC, Vanni A, et al. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 2014;18(3):453– 65. doi: 10.1007/ s11325-014-0989-6.

9. Eichler C, Sommer JU, Stuck BA, et al. Does drug-induced sleep endoscopy change the treatment concept of patient with snoring and obstructive sleep apnea? Sleep Breath 2013;17(1):63– 8. doi: 10.1007/ s11325-012-0647-9.

10. Fernandez-Julián E, García-Pérez MA, García-Gallejo J, et al. Surgical planning after sleep versus awake techniques in patient with obstructive sleep apnea. Laryngoscope 2014;124(8):1970– 4. doi: 10.1002/ lary.24577.

11. Friedman M. Sleep apnea and snoring, surgical and non-surgical therapy. China: Saunders/ Elsevier 2009.

12. Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 2011;268(8):1233– 6. doi: 10.1007/ s00405-011-1633-8.

13. Pileate K, Medts J, Delsupehe KG. Drug-induced sleep endoscopy ganges snoring management plan very significantly compared to standard clinical evaluation. Eur Arch Otorhinolaryngol 2014;271(5):1311– 9. doi: 10.1007/ s00405-013-2795-3.

14. Vroegop VA, Vanderveken OM, Boudewyns N,et al. Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope 2014;124(3):797– 802. doi: 10.1002/ lary.24479.

15. Salamanca F, Constantini F, Bianchi A, et al. Identification of obstructive sites and pattwens in obstructive sleep apnoea synrome by sleep endoscopy in 614 patients. Acta Otorhinolaryngologica Italica 2013;33(4):261– 6.

16. Torre C, Camacho M, Yung-Chuan Liu S, et al. Epiglottis collapse in adult obstructive sleep apnea: a systematic review. Laryngoscope 2016;126(2):515– 23. doi: 10.1002/ lary.25589.

17. Civelek S, Emre IE, Dizdar D, et al. Comparison of conventional continuous positive airway pressure to continuous positive airway pressure titration performed with sleep endoscopy. Laryngoscope 2014;122(3):691– 5. doi: 10.1002/ lary.22494.

18. Kezirian EJ, White DP, Malhotra A, et al. Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 2010;136(4):393– 7. doi: 10.1001/ archoto.2010.26.