Abstract
To illustrate a new technological advance in the standard drug-induced sleep endoscopy (DISE) model, a new machine was used, the Experimental 5 Video Stream System (5VsEs), which is capable of simultaneously visualizing all the decisional parameters on a single monitor, and recording and storing them in a single uneditable video. The DISE procedure was performed on 48 obstructive sleep apnea (OSA) or snoring patients. The parameters simultaneously recorded on a single monitor are (1) the pharmacokinetics and pharmacodynamics of propofol (through the target controlled infusion (TCI) pump monitor), (2) the endoscopic upper airway view, (3) the polygraphic pattern, and (4) the level of sedation (through the bispectral index (BIS) value). In parallel to the BIS recording, the middle latency auditory evoked potential (MLAEP) was also recorded and provided. Recorded videos from the 5VsEs machine were re-evaluated six months later by the same clinician and a second clinician to evaluate the concordance of the therapeutic indications between the two. After the six-month period, the same operator confirmed all their clinical decisions for 45 out of 48 videos. Three videos were no longer evaluable for technical reasons, so were excluded from further analysis. The comparison between the two operators showed a complete adherence in 98% of cases. The 5VsEs machine provides a multiparametric evaluation setting, defined as an “all in one glance” strategy, which allows a faster and more effective interpretation of all the simultaneous parameters during the DISE procedure, improving the diagnostic accuracy, and providing a more accurate post-analysis, as well as legal and research advantages.
Highlights
Obstructive sleep apnea (OSA) syndrome is a condition characterized by the presence of the complete or partial collapse of the upper airway during sleep.The consequences are sleep fragmentation associated with rapid intermittent hypoxia (IH) episodes with activation of the sympathetic nervous system and oxidative stress
In obstructive sleep apnea (OSA) patients who need a better definition of the pathology, in surgical failures, or when patients do not accept continuous positive airway pressure (CPAP) therapy, an analytical procedure known as drug-induced sleep endoscopy (DISE) is used to better design the most suitable alternative treatment
Patients were recruited according to the following criteria: patients affected by snoring and/or OSA with surgery or mandibular advancement device (MAD) indication; patients affected by OSA with surgical failures and not compliant with CPAP treatment
Summary
Obstructive sleep apnea (OSA) syndrome is a condition characterized by the presence of the complete or partial collapse of the upper airway during sleep (apnea and hypopnea, respectively).The consequences are sleep fragmentation associated with rapid intermittent hypoxia (IH) episodes with activation of the sympathetic nervous system and oxidative stress. In OSA patients who need a better definition of the pathology, in surgical failures, or when patients do not accept continuous positive airway pressure (CPAP) therapy, an analytical procedure known as drug-induced sleep endoscopy (DISE) is used to better design the most suitable alternative treatment This procedure allows the observation of the characteristics of the different levels of the upper airway, where soft tissue vibrations and/or an obstruction caused by collapse site(s) may be observed. In this study, we performed DISE using propofol (propofol-DISE), since it allows for quickly obtaining an optimal level of sedation followed by a rapid post-sedation recovery [13,14,15,16,17] This drug requires anesthesiologist management, and the use of a target-controlled infusion (TCI) pump is highly recommended [13]. During propofol-DISE, several parameters are evaluated simultaneously: endoscopic pattern; the pharmacodynamic and pharmacokinetic parameters through a TCI pump, which allows an optimal drug infusion modality and the continuous evaluation of drug concentration levels in the blood and brain [15,18,19,20,21,22]; polygraph recording synchronized with endoscopic images [23,24]; as well as the bispectral index (BIS) [25,26,27], i.e., the level of sedation achieved
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