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Abstract
PurposeThe use of nasal decongestant and nasal anaesthesia is currently not recommended during drug-induced sleep endoscopy (DISE) according to the European position paper. The evaluation of the effects of nasal decongestant/anaesthesia on DISE has not been performed before and our aim is to perform a pilot study to determine whether nasal decongestants/anaesthesia affects DISE outcomes.Methods27 patients undergoing DISE for OSA or for simple snoring were included. On each patient, DISE was performed twice, before and approximately 10 min after the administration of two puffs of co-phenylcaine nasal spray (lidocaine hydrochloride 5%, phenylephrine 0.5%, and benzalkonium chloride 0.01%) into each nostril. A nasal peak inspiratory flow was used for the objective assessment of nasal airway obstruction. During the first and the second DISE the loudness of the snoring was also recorded.ResultsChange in DISE total grading after nasal spray administration was not statistically significant. For the same grading, changes in percentage of contribution to collapse were not statistically significant. Sex, AHI, BMI, tonsils grade, presence of rhinitis, turbinate hypertrophy, nasal septal deviation, or nasal peak inspiratory flow limitation had no influence on the effect of nasal spray. Co-phenylcaine did not significantly influence the loudness of snoring.ConclusionsOur pilot study supports the use of co-phenylcaine nasal spray during DISE and the positive effects of the nasal spray do not influence the grading outcome. Importantly, the decongestant enhances the nasal assessment during DISE and potentially aids in the diagnosis of nasal obstruction while the nasal anaesthetic component may be beneficial by reducing nasal discomfort during DISE and thereby helping to reduce the total dose of intravenous anaesthetic administered. However, further studies on a larger population are needed to confirm our results.
Highlights
Obstructive sleep apnoea (OSA) is the most common sleepdisordered breathing (SDB) disease encountered with a prevalence of 3–17% in the adult population and is associated with an increasing rate of morbidity and mortality [1, 2]
The European position papers do not recommend the use of nasal decongestants and nasal anaesthetics during Drug-induced sleep endoscopy (DISE) owing to the hypothesis that they may affect the grading score outcome [8, 9]
All patients were evaluated with home-based sleep studies before being included in the study, and the diagnosis of simple snoring or OSA was established according to the AHI calculated from the above-mentioned studies as follows: simple snoring, AHI < 5; mild OSA, 5 ≤ AHI < 15; moderate OSA, 15 ≤ AHI < 30; severe OSA, AHI ≥ 30
Summary
Obstructive sleep apnoea (OSA) is the most common sleepdisordered breathing (SDB) disease encountered with a prevalence of 3–17% in the adult population and is associated with an increasing rate of morbidity and mortality [1, 2]. Drug-induced sleep endoscopy (DISE) is a widespread procedure and is considered today as the most common diagnostic procedure for upper airway (UA) endoscopic evaluation for snoring and obstructive sleep apnoea (OSA). Given the known effects of nasal obstruction on SDB [6], nasal decongestant would improve nasal evaluation during DISE by facilitating nasal endoscopic visibility and eliminating the rhinitis/congestion component of nasal blockage. On this regard, we have demonstrated that complete visualisation of both middle turbinates on anterior rhinoscopy predicts a good nasal airway and can be graded [7]. The European position papers do not recommend the use of nasal decongestants and nasal anaesthetics during DISE owing to the hypothesis that they may affect the grading score outcome [8, 9]
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