OSAS and upper pharynx surgery: Does basilingual collapsus always rhyme with failure?

Reproduction of physiological mandibular advancement during adult drug-induced sleep endoscopy

Drug-induced sleep endoscopy (DISE), performed in the operating room, improves airway obstruction phenotyping in obstructive sleep apnea syndrome (OSAS). It pharmacologically approximates human sleep and allows dynamic maneuvers, notably including mandibular advancement, the results of which are predictive of those with a mandibular advancement device (MAD): when obstruction is resolved by mandibular advancement under DISE, a MAD may be indicated. However, individual maximal mandibular advancement in the waking state has to be taken into account, and the MAD should not exceed 75% of this value (MA75), in order to respect temporomandibular joint tolerance. Thus, MA75 needs to be measured and reproduced exactly during DISE in order to assess the clinical indication for MAD in terms of both efficacy and tolerance. The present technical note describes a method for measuring MA75 and reproducing it during DISE with an adapted device so as to select candidates for MAD.

Surgical failure guided by DISE in patients with obstructive sleep apnea: a systematic review and meta-analysis

OBJECTIVES

The failure rate and risk factors of upper airway surgery with drug induced sleep endoscopy (DISE) remain unknown in the treatment of obstructive sleep apnea (OSA). This review aims to analyze the failure rate of upper airway surgery with DISE and identify obstruction sites for surgical failure.

METHODS

A systematic review was conducted using PubMed, Embase, Web of Science, and Google Scholar until May 20th, 2023. We included studies that used DISE to assess obstructive sites before upper airway surgery and reported surgical failure rates and outcomes in patients with OSA.

RESULTS

25 studies with a total of 1522 patients were included in the systematic review and meta-analysis. Upper airway surgery guided by DISE had a relatively low failure rate of 37% (95% CI 0.31-0.44) in the random effects model (I2 = 85.97%, P < 0.001). According to the velum, oropharynx, tongue base, and epiglottis (VOTE) scoring system, major risk factors for surgical failure included circumferential collapse at the velum, lateral wall collapse and small tonsils at the oropharynx, anterior-posterior lingual collapse and complete collapse at the tongue base. High body mass index and large preoperative apnea hypopnea index were also risk factors for OSA surgical failure.

CONCLUSIONS

Upper airway surgery guided by DISE in patients with OSA had a low failure rate of 37%. DISE can identify obstruction sites associated with surgical failure and guide single-level and multi-level surgeries.