Computer-Assisted Quantitative Analysis of Drug-Induced Sleep Endoscopy for Obstructive Sleep Apnea/Hypopnea Syndrome

Interrater reliability of different scoring systems for drug-induced sleep endoscopy

PURPOSE

To explore the interobserver reliability of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) of two classification systems.

METHODS

DISE examinations were recorded digitally for all patients and were evaluated independently by five examiners blinded to all patient data. Areas of obstruction were rated using VOTE (velum, oropharynx lateral wall, tongue base, epiglottis) classification and PTLTbE (palate, tonsils, lateral pharyngeal wall, tongue base, epiglottis) classification. Additionally, palatal coupling was assessed during the jaw thrust maneuver. Interobserver reliability was evaluated with Fleiss' kappa for categorical data and linearly weighted kappa for ordinal data.

RESULTS

In total, 123 patients were included in this study, 92 males and 31 females, with a mean (SD) age of 50.7 (12.1) years and a body mass index (BMI) of 28.3 (5.0) kg/m2. The mean apnea-hypopnea index was 22.2 (18) per hour, and the Epworth Sleepiness Scale was 7.3 (2.3). In our cohort, the interobserver reliability for the VOTE classification ranged from 0.32 to 0.59 and for the PTLTbE classification from 0.23 to 0.49 over all assessed levels, indicating fair to moderate interobserver reliability. The weighted kappa for palatal coupling was 0.37. In the VOTE classification, the level with the best agreement was the velum, while in PTLTbE, the best agreement was observed for tonsillar obstruction.

CONCLUSION

The interrater agreement was fair to moderate for both classifications, with no clear superiority for one classification. The large variability shows the need to objectively quantify upper airway collapse during DISE and natural sleep endoscopy.

Analysis of the cause of retrolingual obstruction in patients with moderate-severe obstructive sleep apnea

PURPOSE

To evaluate the percentage of obstructive sleep apnea (OSA) patients with retrolingual obstruction in all moderate-severe OSA patients and the proportions of different causes in all moderate-severe OSA patients with retrolingual obstruction and to discuss the accuracy of the Friedman tongue position (FTP) and retrolingual cross-sectional area (RCSA) in assessing the retrolingual obstruction.

METHODS

Two hundred and twenty moderate-severe OSA patients were enrolled. After retrolingual obstruction was diagnosed, the percentage of OSA patients with retrolingual obstruction in all moderate-severe OSA patients was calculated. After that, the different causes of retrolingual obstruction were diagnosed based on different diagnostic criteria, and the proportions of different causes in all moderate-severe OSA patients with retrolingual obstruction were calculated. Finally, the correlations between FTP, RCSA, and apnea-hypopnea index after nasopharyngeal tube insertion (NPT-AHI) were analyzed, and the proportions of different causes of retrolingual obstruction based on different FTP and RCSA were observed.

RESULTS

There were 128 patients with retrolingual obstruction, accounting for 58.2% of all moderate-severe OSA patients. In 128 patients with retrolingual obstruction, the proportions of glossoptosis (48.4%), palatal tonsil hypertrophy (28.1%), and lingual hypertrophy (8.6%) were relatively high. Both FTP and RCSA did not correlate with NPT-AHI. The proportion of lingual hypertrophy increased gradually with the increase of FTP and the proportions of glossoptosis in all FTP classifications were high. The patients with RCSA > 180 mm2 were mainly affected by glossoptosis and palatal tonsil hypertrophy, while patients with RCSA ≤ 180 mm2 were mainly affected by lingual hypertrophy.

CONCLUSION

The percentage of patients with retrolingual obstruction in all moderate-severe OSA patients is relatively high, mainly glossoptosis, palatal tonsil hypertrophy, and lingual hypertrophy. FTP classification and RCSA can only reflect the retrolingual anatomical stenosis, but cannot fully reflect the retrolingual functional stenosis, especially the presence of glossoptosis.

Study on the Changes of Liver and Kidney Function-Related Indicators and Clinical Significance in Patients with OSAHS

Purpose

To study the changes of liver and kidney function-related indexes in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and analyze their clinical significance.

Method

Ninety OSAHS patients treated in our hospital from April 2019 to April 2021 were selected. According to the apnea-hypopnea Index (AHI), they were divided into mild OSAHS group (5 ≤ AHI < 15 times/h, 35 people), moderate OSAHS group (15 ≤ AHI < 30 times/h, 35 people), and severe OSAHS group (AHI ≥ 30 times/h, 20 people). In addition, 50 healthy people who underwent physical examination in our hospital at the same time were selected as the control group, and the liver and kidney function and polysomnography (PSG)-related indexes of the above subjects were detected, and the comparison between the groups was carried out.

Result

The serum BUN and SCR levels of the severe group were significantly higher than those of the moderate group, the moderate group had significantly higher levels than the mild group, and the mild group had significantly higher levels than the control group (P < 0.05). The blood AST level of the severe group was significantly lower than that of the moderate group, the moderate group had a significantly lower level than the mild group, and the mild group had a significantly lower level than the control group (P < 0.05). The blood ALT level of the severe group was significantly higher than that of the moderate group, the moderate group had significantly a higher level than the mild group, and the mild group had a significantly higher level than the control group (P < 0.05). The proportions of abnormal liver and kidney function in the control group, mild group, moderate group, and severe group were significantly different (P < 0.05). The AHI of the severe group was significantly higher than that of the moderate group, the moderate group had a higher value than the mild group, and the mild group had a higher value than the control group (P < 0.05). The ASpO2 and MSpO2 of the severe group were significantly lower than those of the moderate group, the moderate group had significantly lower values than the mild group, and the mild group had significantly lower values than the control group (P < 0.05). Spearman correlation analysis showed that the liver and kidney function indexes of OSAHS patients were significantly correlated with PSG indexes (P < 0.05).

Conclusion

Patients with OSAHS will have obvious liver and kidney dysfunction, and the monitoring of liver and kidney function in such patients should be strengthened. If abnormality occurs, early intervention is recommended.

Influencing Factors of Daytime Sleepiness in Patients with Obstructive Sleep Apnea Hypopnea Syndrome and Its Correlation with Pulse Oxygen Decline Rate

Objective

To explore the influencing factors of daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the correlation between daytime sleepiness and pulse oxygen decline rate in patients with severe OSAHS.

Methods

From January 2018 to April 2021, 246 consecutive patients with OSAHS diagnosed by polysomnography (PSG) in our hospital were selected. All patients were grouped according to the minimum nocturnal oxygen saturation and apnea hypopnea index (AHI). There were 33 cases in the no sleep hypoxia group, 34 cases in the mild hypoxia group, 119 cases in the moderate hypoxia group, and 60 cases in the severe hypoxia group. There were 30 cases in the simple snoring group, 55 cases in the mild OSAHS group, 48 cases in the moderate OSAHS group, and 113 cases in the severe OSAHS group. The Epworth Sleepiness Scale (ESS) scores of each group were compared. All patients were grouped according to ESS score. Those with score ≥9 were included in the lethargy group (n = 118), and those with score ≤10 were included in the no lethargy group (n = 128). Univariate and multivariate logistic regression analyses were used to explore the influencing factors of daytime sleepiness in OSAHS patients. Pearson correlation analysis showed the correlation between ESS score and pulse oxygen decline rate in patients with severe OSAHS.

Results

The ESS score of the severe hypoxia group > the moderate hypoxia group > the mild hypoxia group > the no sleep hypoxia group. There was significant difference among the groups (F = 19.700, P < 0.0001). There were significant differences between the severe hypoxia group and other groups and between the moderate hypoxia group and the no sleep hypoxia group and the mild hypoxia group (P < 0.05). The ESS score of the severe OSAHS group > the moderate OSAHS group > the mild OSAHS group > the simple snoring group. There was significant difference among the groups (F = 19.000, P < 0.0001). There were significant differences between the severe OSAHS group and other groups and between the moderate OSAHS group and the simple snoring group (P < 0.05). Univariate analysis showed that BMI, neck circumference, snoring degree, total apnea hypopnea time, AHI, micro arousal index (MAI), oxygen saturation (CT90%), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) were the influencing factors of daytime sleepiness in OSAHS patients (P < 0.05). Multiple logistic regression analysis showed that AHI and CT90% were independent risk factors for daytime sleepiness in OSAHS patients (P < 0.05). Pearson correlation analysis showed that there was a positive correlation between ESS score and pulse oxygen decline rate in patients with severe OSAHS (r = 0.765, P < 0.0001).

Conclusion

OSAHS patients may be accompanied by daytime sleepiness in varying degrees, which may be independently related to AHI and CT90%. The degree of daytime sleepiness in patients with severe OSAHS may be closely related to the decline rate of pulse oxygen, which should be paid great attention in clinic.