Comparison of Findings between Clinical Examinations and Drug-Induced Sleep Endoscopy in Patients with Obstructive Sleep Apnea Syndrome.

Huan-Yu Lin,Tyler Nelson,Yung-An Tsou,Yi-Chih Lin,Liang-Chun Shih,Wen-Dien Chang,Ying-Shuo Hsu

doi:10.3390/ijerph17176041

Abstract

The Velum, Oropharynx, Tongue base and Epiglottis (VOTE) classification on drug-induced sleep endoscopy (DISE) is used widely for obstructive sleep apnea (OSA) syndrome, though research into comparative physical examinations with VOTE on DISE is still limited. The aim of this study was to evaluate the relationship between the findings of physical examinations and DISE in patients with OSA. Fifty-five patients with OSA were enrolled in this retrospective study. All of the patients received clinical explorations including a Brodsky classification, a modified Mallampati score (MMS), a modified Friedman’s staging system, and a Muller’s test. Drug-induced sleep endoscopy was further evaluated in the operating room. There were significant relationships between Brodsky classification, modified Friedman’s staging system, Muller’s test and oropharynx collapse during DISE (p < 0.05). Brodsky classification, MMS, modified Friedman’s staging system and retropalatal lateral-to-lateral (L–L) collapse of Muller’s test were significantly correlated with VOTE count (p < 0.05). The concordance between VOTE under DISE and Brodsky classification or modified Friedman’s staging system was moderate. In contrast, the concordance between VOTE under DISE and MMS or Muller’s test was slight. The study revealed that Brodsky classification and Friedman staging had a significant relationship with DISE on the velum and oropharynx, but the level of tongue base is uncertain between DISE and MMS. Correlation of awake evaluation of tongue base is still not correlated to the DISE findings. Pre-treatment evaluation of DISE is still warranted.

Highlights

Obstructive sleep apnea (OSA) syndrome is characterized by a repetitive upper airway collapse during sleep, narrowing the pathway for airflow and causing periods with hypopnea and apnea with decreased blood oxygen levels [1]
The study sample consisted of 55 patients (44 men and 11 women; age = 44.9 ± 12.9 years, body mass index (BMI) = 30.6 ± 4.7 Kg/m2 ; and apnea-hypopnea index (AHI) = 44.6 ± 22.0/hr)
Comparing the clinical characteristics and physical examinations between the patients with severe OSA (AHI > 30/hr) and not-severe OSA (AHI ≤ 30/hr), there were no significant differences in age, Brodsky classification grade, Mallampati score (MMS), modified Friedman’s staging system, Muller’s test and collapse level under drug-induced sleep endoscopy (DISE) (p > 0.05) except BMI (p < 0.05, Table 1)

Summary

Introduction

Obstructive sleep apnea (OSA) syndrome is characterized by a repetitive upper airway collapse during sleep, narrowing the pathway for airflow and causing periods with hypopnea and apnea with decreased blood oxygen levels [1]. Continuous positive airway pressure (CPAP) therapy remains the gold standard for the conservative treatment of OSA. PSG is a gold standard to assess sleep diseases, but it has some disadvantages, such as sleep testing and data recording all night, performing in an unfamiliar environment, and affecting normal sleep due to limited channel monitoring. Croft et al first tried to use endoscopy for upper airway under sedation [5], and drug-induced sleep endoscopy (DISE) is used widely for OSA. DISE could assess the upper airway similar to natural sleep via endoscopic evaluation. It has high validity and reliability for the identification of specific anatomical structures that contribute to obstruction [6,7]

Objectives

Methods

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Discussion

Conclusion