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Nomura T, Horikoshi T, Kitano Y, Yamada M, Kondo K, Kikuchi S. The morphometrical evaluation after uvulopalatopharyngoplasty. Sleep Breath 2024; 28:869-875. [PMID: 37792164 DOI: 10.1007/s11325-023-02926-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of uvulopalatopharyngoplasty (UPPP) and the corresponding postoperative morphometrical changes. METHODS Patients diagnosed with obstructive sleep apnea syndrome who complained of snoring and apnea were enrolled in this study. Pre- and postoperative tests, including CTs, pharyngeal volume (PV), cross-sectional area (CSA), and six-category morphometrical studies, were performed. RESULTS Of 11 patients included, 10 showed improvement of symptoms. BMI correlated with the respiratory event index (REI). In terms of PV, there was a significantly wider postoperative area. The rate of change between preoperative REI and postoperative REI (ΔREI) correlated with the amount of change of PV between preoperative PV and postoperative PV (ΔPV). CSA increased postoperatively and correlated with REI. Uvula space (UV) and distance between the hyoid bone and the base of the tongue (HB) increased postoperatively, and posterior airway space (PAS) and epiglottic space (Epi) decreased postoperatively. UV and PAS were significant (p = 0.046, 0.014). UV was related to REI. CONCLUSION Widening the PV, increasing CSA, and the posterior movement of the tongue base after UPPP surgery were found. The improvement of REI did not depend only on volume. These results suggest that it was important not only to widen the PV but also to improve the shape of the pharynx.
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Affiliation(s)
- Tsutomu Nomura
- Division of Head & Neck Surgery/Otolaryngology, Department of Comprehensive Medical Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama, 350-0283, Japan.
| | - Tomomi Horikoshi
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yuka Kitano
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masato Yamada
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shigeru Kikuchi
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Udayakumar SIV, Jo HJ, Kim HY, Joo EY, Paeng JY. Gender differences in the upper airway, craniofacial morphological and polysomnographic parameters in patients with obstructive sleep apnoea. J Oral Rehabil 2024; 51:581-592. [PMID: 37962252 DOI: 10.1111/joor.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/18/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a common sleep disorder characterized by repetitive episodes of upper airway collapse during sleep associated with arousals with or without oxygen desaturation. OBJECTIVE This study aims to assess and analyse the morphological and neurological factors associated with obstructive sleep apnoea using polysomnography study data and two-dimensional cephalometric analysis of airway and skeletal parameters and their correlation in the patients with varying severities of obstructive sleep apnoea. METHODS This study included 892 patients who underwent a complete work up, including a thorough history, clinical examination, standard polysomnography study and 2D cephalometric analysis to diagnose obstructive sleep apnoea. This study divided the participants into two groups based on the AHI score from the PSG study: AHI < 15 and AHI > 15 groups. The groups were further divided into male and female groups to study the prevalence of OSA. The analysis involved 13 cephalometric parameters: Seven linear and six angular measurements. The airway parameters measured in this study were minimum posterior airway space (PAS_min), hyoid bone to the mandibular plane (H_MNP) and soft palate length (SPL). All the subjects in this study underwent a standard overnight polysomnography study at the sleep centre in Samsung Medical Center. RESULTS A total of 892 adult participants (M: F = 727:165, mean age: 50.6 ± 13.2 years and age range: 18-85 years). AHI >15 group was significantly older with higher BMI, NC and WC compared to the AHI < 15 groups in both male and female groups. There was statistical significance observed in N1, N3, AI, ODI, lowest saturation (%) and apnoea max length between the groups (p < .001). The arousal index (AI), especially the respiratory arousal index was considerably higher in the male group. There were significantly higher values in all the PSG parameters in the male group. In the airway parameters, hyoid bone position and soft palate length showed significant differences (p < .001), whereas the PAS did not show any differences (p = .225) between the AHI <15 and AHI >15 groups. The overall skeletal cephalometric parameters showed no significant differences between the groups, whereas the gonial angle and AB to mandibular plane angle showed significant differences in the female group (p = .028, p = .041 respectively). CONCLUSION The partial correlation of cephalometric parameters with AHI showed a stronger correlation between the H_MNP and AHI in both men and women. The position of the hyoid bone and the soft palate length influences the progression of OSA, especially in male patients. This study found no direct association between the minimum PAS and varying severities of OSA in men and women. We speculate that more than the craniofacial morphological factors such as the sagittal and vertical position of the maxilla and the mandible, the position of the hyoid bone might be more responsible for the severity of OSA.
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Affiliation(s)
- Santhiya Iswarya Vinothini Udayakumar
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Samsung Medical Center, Sungkyungkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jin Jo
- Department of Neurology, Samsung Medical Center, Sungkyungkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyungkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Sungkyungkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun-Young Paeng
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Samsung Medical Center, Sungkyungkwan University School of Medicine, Seoul, Republic of Korea
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Cebola P, Caroça C, Donato H, Campos A, Dias SS, Paço J, Manso C. Computed Tomography versus Sleep Endoscopy (DISE) to Predict the Effectiveness of Mandibular Advancement Devices in Adult Patients with Obstructive Sleep Apnea: A Protocol for Systematic Review. J Clin Med 2023; 12:6328. [PMID: 37834971 PMCID: PMC10573249 DOI: 10.3390/jcm12196328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Obstructive sleep apnea is a sleep disorder with a high prevalence in the world population. The mandibular advancement device is one of the options for treating obstructive sleep apnea. Neck computed tomography and drug-induced sleep endoscopy are complementary diagnostic tests that may help predict the effectiveness of mandibular advancement devices. This study aims to analyze the best method for predicting the effectiveness of mandibular advancement devices in the therapeutic approach to obstructive sleep apnea. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection databases will be comprehensively searched. We will include randomized clinical trials, non-randomized prospective or retrospective clinical studies, case controls, cohort studies, and case series. Two authors will independently conduct data extraction and assess the literature quality of the studies. The analysis of the included literature will be conducted by Revman 5.3 software. The outcomes that will be analyzed are craniofacial characteristics, cephalometric assessments, site and type of obstruction of the upper airway, mean values of the apnea-hypopnea index, and SaO2 verified in the initial and follow-up polysomnography. This study will provide reliable, evidence-based support for the clinical application of mandibular advancement devices for obstructive sleep apnea.
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Affiliation(s)
- Pedro Cebola
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (P.C.); (C.M.)
- CUF Tejo Hospital, 1300-352 Lisboa, Portugal; (A.C.); (J.P.)
| | - Cristina Caroça
- CUF Tejo Hospital, 1300-352 Lisboa, Portugal; (A.C.); (J.P.)
- CHRC, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1169-056 Lisboa, Portugal
| | - Helena Donato
- Documentation and Scientific Information Service, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Ana Campos
- CUF Tejo Hospital, 1300-352 Lisboa, Portugal; (A.C.); (J.P.)
| | - Sara Simões Dias
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC) da NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), CEDOC—Campus Sant’Ana, Pólo de Investigação, NMS, UNL, Edifício Amarelo, Rua do Instituto Bacteriológico no. 5, 1150-082 Lisboa, Portugal;
- EpiSaúde Sociedade Científica, 7005-837 Évora, Portugal
- Escola Superior de Saúde do Instituto Politécnico de Leiria, Unidade de Investigação em Saúde (UI), 2411-901 Leiria, Portugal
| | - João Paço
- CUF Tejo Hospital, 1300-352 Lisboa, Portugal; (A.C.); (J.P.)
- CHRC, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1169-056 Lisboa, Portugal
| | - Cristina Manso
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (P.C.); (C.M.)
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Mooney KL, Brooks Peterson M, Skirko JR, Friedman NR. The Quest for a DISE Protocol. Otolaryngol Head Neck Surg 2021; 167:590-599. [PMID: 34399647 DOI: 10.1177/01945998211036645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this quality initiative project was to modify our existing institutional drug-induced sleep endoscopy (DISE) protocol so that the surgeon could consistently determine obstructive breathing patterns while minimizing children's discomfort. METHODS A quality initiative study utilizing the well-described plan-do-study-act (PDSA) process was conducted at a tertiary hospital for children with polysomnogram-documented obstructive sleep apnea who were undergoing DISE. A 4-point Likert measurement tool was created. Change in each Likert rating with subsequent PDSA cycle was tested with the Wilcoxon rank sum test (Mann-Whitney), and change across all PDSA cycles was tested with the Kruskal-Wallis equality-of-populations rank test. RESULTS After a series of 4 PDSA cycles with 81 children, the DISE protocol was streamlined from 14 to 9 steps. There was significant improvement for all aspects of the DISE, with a final overall median rating of 1 (excellent) for intravenous (IV) placement, scope insertion, and anesthesiologist and surgeon satisfaction (P < .01). DISCUSSION For sleep surgeons, DISE is quickly becoming what bronchoscopy is to the airway surgeon. Utilizing inhalational agents to obtain IV access and insert the flexible scope in the rapid "on-off" fashion optimizes DISE success regardless of the primary sedation medication and allows ample time for these agents to dissipate. IMPLICATIONS FOR PRACTICE Adoption of a DISE protocol that includes nasal premedication and inhalational volatile gases for IV and scope insertion at the onset provides a more predictable level of sedation that is well tolerated by the patient, enabling the otolaryngologist to create an obstructive sleep apnea treatment plan.
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Affiliation(s)
- Kristin L Mooney
- Department of Surgery, Children's Hospital Colorado, Broomfield, Colorado, USA
| | - Melissa Brooks Peterson
- Department of Anesthesiology, School of Medicine, University of Colorado, Aurora, Colorado, USA.,Division of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jonathan R Skirko
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Norman R Friedman
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA.,Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado, USA
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Correlation of site of obstruction between two dynamic evaluation modalities in obstructive sleep apnea patients: drug-induced sleep endoscopy and sleep videofluoroscopy. Sleep Breath 2020; 25:1587-1592. [PMID: 33089400 DOI: 10.1007/s11325-020-02225-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/12/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Drug-induced sleep endoscopy (DISE) and sleep videofluoroscopy (SVF) are two dynamic modalities for evaluating the upper airway in patients with obstructive sleep apnea (OSA). We evaluated the correlation of obstructive sites determined by DISE and SVF in OSA patients and elucidate findings that can improve the accuracy of upper airway assessment. METHODS A consecutive series of 63 patients with OSA who underwent DISE and SVF were the subjects of this study. The DISE and SVF findings were divided according to the anatomical structure responsible for the collapse, including the soft palate (SP), oropharyngeal lateral walls (LW), tongue base (TB), and larynx (LX). The obstruction was graded on the three-point scale: 0, no obstruction; 1, partial obstruction; or 2, complete obstruction. Additionally, grade 1.5 TB obstruction was designated when the posterior displacement of the anterior tongue was detected during simultaneous retropalatal obstruction. The agreement rate and Cohen's kappa test between the two modalities were also assessed. RESULTS The agreement rate between the two modalities was highest in LX (88.9%) followed by SP (85.7%), TB (76.1%), and LW (74.6%) (Cohen's kappa value = 0.757 in LX, 0.642 in SP, 0.637 in TB, 0.612 in LW, respectively). When grade 1.5 and 2 TB obstructions were combined, the agreement rate increased to 88.9% (Cohen's kappa value = 0.757). CONCLUSIONS We found a good overall agreement between the two dynamic airway evaluation modalities during drug-induced sleep, and this correlation may be improved if the posterior displacement of the anterior tongue during DISE is used as a sign of TB obstruction.
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Abstract
PURPOSE OF REVIEW The purpose of this article is to highlight recent advances in the burgeoning field of drug-induced sleep endoscopy (DISE). RECENT FINDINGS One of the first studies to investigate the correlation of DISE findings and natural sleep endoscopy found good agreement in clinically significant obstruction. Previous studies have shown good agreement of DISE findings with the use of different sedative agents implying that the choice of sedative may not be crucial. However, recent studies show variable patterns of collapse, especially at the tongue base, with the use of different sedative agents. A universally accepted classification scheme for drug-induced sleep endoscopy is lacking. A new DISE classification system, termed Palate, Tonsils, Lateral pharyngeal wall, Tongue base, Epiglottis, was introduced this year with the noted advantage of being able to better differentiate between clinically relevant tonsillar and lateral pharyngeal wall collapse. Despite recent advances in the field, there remains no general consensus that DISE findings predict surgical success but may aid in the identification of patients who will respond well to oral appliance therapy. SUMMARY Drug-induced sleep endoscopy is a structure-based evaluation of the upper airway that more closely resembles the natural sleep state compared with awake evaluation.
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Whyte A, Gibson D. Imaging of sleep-disordered breathing in adults. Clin Radiol 2020; 75:960.e1-960.e16. [PMID: 32620255 DOI: 10.1016/j.crad.2020.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
Sleep-disordered breathing (SDB) is a term that includes several chronic conditions in which partial or complete cessation of breathing occurs multiple times throughout the night. Central sleep apnoea (CSA) is uncommon and defined by the episodic cessation of airflow without respiratory effort. Lesions involving the respiratory centre in the brainstem or the origin of the phrenic nerve from the mid-cervical cord are the commonest structural causes of CSA; magnetic resonance imaging (MRI) will demonstrate the lesion and frequently suggest the likely aetiology. In contrast, obstructive sleep apnoea (OSA) is defined as upper airway obstruction despite ongoing respiratory effort. Repetitive episodes of narrowing or closure of the upper airway are the predominant cause leading to snoring and OSA, respectively. OSA affects 33-40% of the adult population and is associated with multiple adverse health consequences, including a significantly increased risk of serious morbidity and mortality. The incidence is increasing proportionally to the worldwide rise in obesity. Imaging, performed primarily without the involvement of radiologists, has been integral to understanding the anatomical basis of SDB and especially OSA. This article will review the pathophysiology, imaging findings, and sequelae of these common conditions. The role of imaging both in suggesting the incidental diagnoses of SDB and in the investigation of these conditions when the diagnosis is suspected or has been established are also discussed.
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Affiliation(s)
- A Whyte
- Perth Radiological Clinic, Subiaco, WA 6008, Australia; Departments of Surgery and Dentistry, University of Western Australia, Nedlands, WA 6009, Australia; Departments of Medicine and Radiology, University of Melbourne, Carlton, Victoria 3000, Australia.
| | - D Gibson
- Departments of Surgery and Dentistry, University of Western Australia, Nedlands, WA 6009, Australia; Imaging Department, Fiona Stanley Hospital, Murdoch, WA 6150, Australia; Department of Medicine, Curtin Medical School, Bentley, WA 6102, Australia
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Upper airway morphological changes in obstructive sleep apnoea: effect of age on pharyngeal anatomy. The Journal of Laryngology & Otology 2020; 134:354-361. [PMID: 32284084 DOI: 10.1017/s0022215120000766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea. METHODS A total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed. RESULTS Soft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2. CONCLUSION A number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.
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Zhao W, Zhao L, Zhao Y, Guo Z, Guo J, Lin C, Chiang RPY. Technology on sleep surgery. Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00261-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ghorbani J, Adimi Naghan P, Safavi Naeini A, Sadeghi Haghighi K. Can be compared obstructive respiratory events during drug induced sleep endoscopy (DISE) and nocturnal polysomnography. Eur Arch Otorhinolaryngol 2020; 277:1379-1384. [DOI: 10.1007/s00405-020-05848-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/04/2020] [Indexed: 11/28/2022]
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Whyte A, Gibson D. Adult obstructive sleep apnoea: Pathogenesis, importance, diagnosis and imaging. J Med Imaging Radiat Oncol 2019; 64:52-66. [PMID: 31788980 DOI: 10.1111/1754-9485.12978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/15/2019] [Indexed: 01/10/2023]
Abstract
Obstructive sleep apnoea (OSA) is a serious worldwide health problem. Moderate-to-severe OSA has been found in up to 50% of men and 25% of women in the middle-aged population. It results in a fourfold increase in all causes of mortality. The prevalence of OSA is underestimated, partly due to absence of symptoms but also lack of knowledge amongst the population at large as well as sectors of the medical profession. Imaging, performed predominantly by clinicians and research scientists, has been integral to evaluating the anatomical basis of OSA. Increased nasal resistance and a narrowed and elongated oropharynx lead to increased collapsibility of the upper airway, predisposing to airway collapse and apnoea during sleep when there is reduction in tone of the pharyngeal dilator muscles. Unfortunately, a significantly narrowed upper airway is usually ignored by radiologists: it is not part of their reporting 'check-list'. The imaging findings in the upper airway that are strongly associated with OSA and its sequelae in various organ systems are discussed. Imaging can strongly suggest OSA; the diagnosis requires a polysomnogram for confirmation. Treatment of moderate-to-severe disease is primarily with positive airway pressure applied by a nasal or oral mask which splints the upper airway. Although highly effective, compliance is limited and other treatment modalities are increasingly being utilized.
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Affiliation(s)
- Andy Whyte
- Perth Radiological Clinic, Perth, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Daren Gibson
- Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Prediction of tongue obstruction observed from drug induced sleep computed tomography by cephalometric parameters. Auris Nasus Larynx 2018; 46:384-389. [PMID: 30262210 DOI: 10.1016/j.anl.2018.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/15/2018] [Accepted: 08/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To elucidate potential role of cephalometric measurements to predict tongue base obstruction as observed on drug Induced Sleep Computed Tomography (DIS-CT). METHODS Study included 35 patients with moderate to severe sleep apnea who underwent DIS-CT & cephalometric examination to assess tongue base obstruction. RESULTS Statistically significant difference was noted for SNA angle & Mandibular posterior airway space (PAS) among groups with total tongue obstruction versus Non-total tongue obstruction identified on DIS-CT. CONCLUSION Lateral cephalogram can be used as a standard screening tool with commonly used skeletal and soft tissue parameters to predict the possibility of tongue collapse/obstruction during sleep in patient with moderate to severe OSAS.
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Lim JS, Lee JW, Han C, Kwon JW. Correlation of soft palate length with velum obstruction and severity of obstructive sleep apnea syndrome. Auris Nasus Larynx 2018; 45:499-503. [DOI: 10.1016/j.anl.2017.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/24/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
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Oh MS, Dedhia RC. Current Techniques and Role of Drug-Induced Sleep Endoscopy for Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0082-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yoon BW, Hong JM, Hong SL, Koo SK, Roh HJ, Cho KS. A comparison of dexmedetomidine versus propofol during drug-induced sleep endoscopy in sleep apnea patients. Laryngoscope 2015; 126:763-7. [PMID: 26649458 DOI: 10.1002/lary.25801] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS In this study, we compared the effects of propofol and dexmedetomidine on the upper airway collapse pattern and cardiopulmonary parameters of patients with obstructive sleep apnea (OSA) undergoing drug-induced sleep endoscopy (DISE). STUDY DESIGN Prospective, single center, observational study MATERIALS AND METHODS The 50 patients with OSA underwent 30 minutes of DISE on 2 different days, the first time with propofol target-controlled infusion (TCI) and the second time with dexmedetomidine TCI. Both the characteristics of upper airway obstruction and cardiopulmonary parameters in response to the depth of sedation achieved with each drug were evaluated. RESULTS The results obtained with propofol and dexmedetomidine DISE were in excellent agreement for all sites of obstruction irrespective of the depth of sedation. Although partial or total obstruction at all areas was consistently observed using both drugs, the degree of upper airway narrowing was slightly lower with dexmedetomidine than with propofol. However, the percentage of patients with a greater than 20% change in blood pressure and heart rate compared to baseline was significantly higher in response to propofol than to dexmedetomidine (P = 0.003 and P < 0.001, respectively). Minimal oxygen saturation was significantly lower in DISE with propofol than with dexmedetomidine (P = 0.004). The percentage of patients with oxygen saturation less than 90% or 80% during DISE was significantly higher in response to propofol than to dexmedetomidine (P = 0.032 and P < 0.001, respectively). CONCLUSION The DISE findings achieved with propofol and dexmedetomidine were in excellent agreement. However, during DISE, dexmedetomidine provided greater hemodynamic stability and less respiratory depression than propofol. LEVEL OF EVIDENCE 4. Laryngoscope, 126:763-767, 2016.
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Affiliation(s)
- Byung-Woo Yoon
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong-Min Hong
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Sung-Lyong Hong
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Kweon Koo
- Department of Otorhinolaryngology, Busan St. Mary's Medical Center, Busan, Republic of Korea
| | - Hwan-Jung Roh
- Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
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Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, Nischal N, Sethi P, Behera D, Bhatia M, Ghoshal AG, Gothi D, Joshi J, Kanwar MS, Kharbanda OP, Kumar S, Mohapatra PR, Mallick BN, Mehta R, Prasad R, Sharma SC, Sikka K, Aggarwal S, Shukla G, Suri JC, Vengamma B, Grover A, Vijayan VK, Ramakrishnan N, Gupta R. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition). Lung India 2015; 32:422-34. [PMID: 26180408 PMCID: PMC4502224 DOI: 10.4103/0970-2113.159677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.
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Affiliation(s)
- Surendra K Sharma
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Vishwa Mohan Katoch
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
| | - Alladi Mohan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - T Kadhiravan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - A Elavarasi
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - R Ragesh
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Neeraj Nischal
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Prayas Sethi
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - D Behera
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manvir Bhatia
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Medanta Hospital, Gurgaon, Haryana, India
| | - A G Ghoshal
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Dipti Gothi
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Employees' State Insurance Corporation, Post Graduate Institute of Medical Sciences and Research, New Delhi, India
| | - Jyotsna Joshi
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Topiwala National Medical College, Mumbai, Maharashtra, India
| | - M S Kanwar
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, New Delhi, India
| | - O P Kharbanda
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Suresh Kumar
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sree Balaji Medical College and Hospital, Bharath University, Chennai, Tamil Nadu, India
| | - P R Mohapatra
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - B N Mallick
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Ravindra Mehta
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, Bengaluru, Karnataka, India
| | - Rajendra Prasad
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; VP Chest Institute, New Delhi, India
| | - S C Sharma
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Kapil Sikka
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Sandeep Aggarwal
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Garima Shukla
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - J C Suri
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Safdarjung Hospital, New Delhi, India
| | - B Vengamma
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Ashoo Grover
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
| | - V K Vijayan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, Bhopal, Madhya Pradesh, India
| | - N Ramakrishnan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Rasik Gupta
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
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Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, Nischal N, Sethi P, Behera D, Bhatia M, Ghoshal A, Gothi D, Joshi J, Kanwar M, Kharbanda O, Kumar S, Mohapatra P, Mallick B, Mehta R, Prasad R, Sharma S, Sikka K, Aggarwal S, Shukla G, Suri J, Vengamma B, Grover A, Vijayan V, Ramakrishnan N, Gupta R. Consensus & evidence-based INOSA Guidelines 2014 (first edition). Indian J Med Res 2014; 140:451-68. [PMID: 25366217 PMCID: PMC4248396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive sleep apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or co-morbidities or ≥ 15 such episodes without any sleep related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.
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Affiliation(s)
- Surendra K. Sharma
- All India Institute of Medical Sciences (AIIMS), New Delhi, India,Reprint requests: Dr Surendra K. Sharma, Professor & Head; Department of Medicine All India Institute of Medical Sciences, Anasari Nagar, New Delhi 110 029, India e-mail:
| | | | - Alladi Mohan
- Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, India
| | - T. Kadhiravan
- Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - A. Elavarasi
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R. Ragesh
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neeraj Nischal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prayas Sethi
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - D. Behera
- Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | | | - A.G. Ghoshal
- National Allergy Asthma Bronchitis Institute (NAABI), Kolkata, India
| | - Dipti Gothi
- Employees’ State Insurance Corporation- Post Graduate Institute of Medical Sciences & Research (ESI-PGIMSR), New Delhi, India
| | - Jyotsna Joshi
- Topiwala National (TN) Medical College, Mumbai, India
| | | | - O.P. Kharbanda
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Suresh Kumar
- Sree Balaji Medical College & Hospital, Bharath University Chennai, India
| | | | - B.N. Mallick
- School of Life Sciences, Jawaharlal Nehru University (JNU), New Delhi, India
| | | | | | - S.C. Sharma
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kapil Sikka
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sandeep Aggarwal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Garima Shukla
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - J.C. Suri
- Safdarjung Hospital, New Delhi, India
| | - B. Vengamma
- Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, India
| | - Ashoo Grover
- Indian Council of Medical Research (ICMR), New Delhi, India
| | | | | | - Rasik Gupta
- Indian Council of Medical Research (ICMR), New Delhi, India
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Upper airway collapse during drug induced sleep endoscopy: head rotation in supine position compared with lateral head and trunk position. Eur Arch Otorhinolaryngol 2014; 272:485-8. [DOI: 10.1007/s00405-014-3215-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/29/2014] [Indexed: 11/26/2022]
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De Vito A, Carrasco Llatas M, Vanni A, Bosi M, Braghiroli A, Campanini A, de Vries N, Hamans E, Hohenhorst W, Kotecha BT, Maurer J, Montevecchi F, Piccin O, Sorrenti G, Vanderveken OM, Vicini C. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 2014; 18:453-65. [PMID: 24859484 DOI: 10.1007/s11325-014-0989-6] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 04/04/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting. METHODS The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique. RESULTS A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the terminology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied sedation drugs and observation windows. Otherwise, no consensus has been reached on a scoring and classification system. CONCLUSIONS Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking.
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Affiliation(s)
- Andrea De Vito
- Special Surgery Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Via Forlanini 34, 47121, Forlì, Italy
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Carrasco Llatas M, Dalmau Galofre J, Zerpa Zerpa V, Marcano Acuña M, Mompó Romero L. Drug-induced Sleep Videoendoscopy: Clinical Usefulness and Literature Review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2014.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang P, Ye J, Pan C, Xian J, Sun N, Li J, Zhang Y, Kang D. Comparison of drug-induced sleep endoscopy and upper airway computed tomography in obstructive sleep apnea patients. Eur Arch Otorhinolaryngol 2014; 271:2751-6. [DOI: 10.1007/s00405-014-3051-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/03/2014] [Indexed: 11/30/2022]
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Fernández-Julián E, García-Pérez MÁ, García-Callejo J, Ferrer F, Martí F, Marco J. Surgical planning after sleep versus awake techniques in patients with obstructive sleep apnea. Laryngoscope 2014; 124:1970-4. [DOI: 10.1002/lary.24577] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/09/2013] [Accepted: 12/30/2013] [Indexed: 11/07/2022]
Affiliation(s)
| | - Miguel Ángel García-Pérez
- Institute of Health Research INCLIVA and Department of Genetics; University of Valencia; Valencia Spain
| | | | - Felipe Ferrer
- Otorhinolaryngology Department; University of Valencia; Valencia Spain
| | - Francisco Martí
- Department of Anesthesiology; Hospital Clínico Universitario; University of Valencia; Valencia Spain
| | - Jaime Marco
- Otorhinolaryngology Department; University of Valencia; Valencia Spain
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Heo SJ, Park CM, Kim JS. Time-dependent changes in the obstruction pattern during drug-induced sleep endoscopy. Am J Otolaryngol 2014; 35:42-7. [PMID: 24051233 DOI: 10.1016/j.amjoto.2013.08.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/10/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Drug-induced sleep endoscopy (DISE) is used to identify the site of obstruction causing obstructive sleep apnea (OSA). However, previous studies have reported a wide range of DISE findings, and new patterns of airway obstruction have also been observed during postoperative DISE. Therefore, we aimed to determine the features of changes in obstructive patterns during DISE. MATERIALS AND METHODS Forty-two patients diagnosed with OSA underwent DISE for 25 min. Sites of obstruction were determined at the levels of the velum, lateral wall of the oropharynx, tongue base, and epiglottis. The velum obstruction configuration was classified as anteroposterior, lateral, or concentric. RESULTS The obstructive pattern changed in 14 patients (33%). We observed a change in the site of obstruction in 9 patients (21.4%) and in the configuration of velum obstruction in 5 patients (11.9%). The changes occurred between 3 and 22 min after commencing DISE (mean, 10.6 ± 6.2 min). The proportion of obstructions in the velum, lateral wall of the oropharynx, and tongue base increased with longer DISE durations. The proportion of multiple-level obstructions increased significantly after 15 min (P<0.05). In the velum, anteroposterior obstructions in 2 patients and lateral obstructions in 3 patients changed into concentric obstructions. More configurations were observed with longer procedure durations. CONCLUSIONS Hence, we assume that it is possible to miss the site of obstruction during DISE if the procedure is too short, which may partly explain the discrepancies between studies.
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Ha JG, Min HJ, Ahn SH, Kim CH, Yoon JH, Lee JG, Cho HJ. The dimension of hyoid bone is independently associated with the severity of obstructive sleep apnea. PLoS One 2013; 8:e81590. [PMID: 24312562 PMCID: PMC3846888 DOI: 10.1371/journal.pone.0081590] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction We hypothesized that the size of the hyoid bone itself may affect the severity of sleep apnea. The aim of this study was to identify the relationship between hyoid bone dimensions and the severity of sleep apnea using computerized tomography (CT) axial images. Methods We retrospectively measured the hyoid bone in axial images of neck CTs and correlated these measurements with results of polysomnography in a total of 106 male patients. The new hyoid bone parameters studied in this study were as follows: distance between bilateral lesser horns (LH-d), distance between bilateral greater horns (GH-d), distance from the most anterior end of the hyoid arch to GH-d (AP), distance from the greater to the lesser horn on right and left sides (GH-LH), and the anterior angle between bilateral extensive lines from the greater to the lesser horn (H-angle). Data was analyzed using univariate and multivariate logistic regression, and Pearson correlation tests. Results We found a significant inverse correlation between the apnea-hypopnea index (AHI) and GH-d or AP. Neither the LH-d, GH-LH, nor H-angle were associated with the AHI. The patient group that met the criteria of both GH-d<45.4 and AP<33.4 demonstrated the most severe AHI. Conclusion The lateral width or antero-posterior length of hyoid bone was associated with AHI and predicted the severity of sleep apnea in male patients. This finding supports the role of expansion hyoidplasty for treatment of sleep apnea. Pre-operative consideration of these parameters may improve surgical outcomes in male patients with sleep apnea.
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Affiliation(s)
- Jong Gyun Ha
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyeon Ahn
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Airway Mucus Istitute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Airway Mucus Istitute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeung-Gweon Lee
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Airway Mucus Istitute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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27
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[Drug-induced sleep videoendoscopy: clinical usefulness and literature review]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 65:183-90. [PMID: 24094447 DOI: 10.1016/j.otorri.2013.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/17/2013] [Accepted: 06/20/2013] [Indexed: 11/23/2022]
Abstract
Fiberoptic examination of the pharynx under drug-induced sleep is a test that helps to detect the areas of vibration and collapse in patients with sleep-disordered breathing. This article is a review of the available literature on the subject, aimed at helping otolaryngologists to understand the procedure and to resolve some controversies surrounding it.
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Drug-induced sleep endoscopy: a two drug comparison and simultaneous polysomnography. Eur Arch Otorhinolaryngol 2013; 271:181-7. [PMID: 23665745 DOI: 10.1007/s00405-013-2548-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
The purpose of the present study was to compare pharyngeal and polysomnographical findings during drug-induced sleep endoscopy (DISE) performed with either propofol or midazolam as a single sedative agent. It is prospective, non-randomized, double-blinded case series study. Sixteen patients with sleep disordered breathing were sedated first with propofol and after full wake up with midazolam. Simultaneous polysomnography (PSG) was performed. We compared the zones of obstruction and vibration found with both drugs using the VOTE classification. Simultaneous PSG findings are also compared. There were 15 men and one woman; the mean age was 42.7 years old, mean body mass index 26.9 kg/m(2). Average DISE duration was 20 min with Propofol and 14.3 min with Midazolam. The induced sleep stage obtained was N2 with both drugs. Outpatient physical exam did not correlate with drug-induced sleep findings. There was a good correlation between DISE results with both drugs in all the areas of collapse except the velum (p < 0.005). Using a continuous perfusion, there is a good agreement in the findings observed in DISE performed with propofol and midazolam and PSG.
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