Comparison of findings of awake and induced sleep fiberoptic nasoendoscopy in cases of snoring and obstructive sleep apnea

Abstract

BackgroundIdentifying the site of obstruction and the pattern of airway change during sleep are the key points essential to guide surgical treatment decision making for snoring and obstructive sleep apnoea–hypopnoea syndrome (OSAHS) in adults. The use of nasopharyngoscopy during the application of the Müller maneuver is frequently employed to establish the site of upper airway obstruction. The Müller maneuver, however, is used when the patient is awake and therefore may not correlate with obstruction occurring during sleep. Drug-induced sleep endoscopy (DISE) avoids these drawbacks and may provide a more accurate evaluation of the upper airway. ObjectiveThe goal of this study is to compare videoendoscopic findings under induced sleep and those during the awake Müller’s maneuver in order to provide an ideal and objective method for accurate assessment of upper airway in cases of snoring and obstructive sleep apnea. This will facilitate choosing the proper line of treatment and monitoring the effect of management. Design50 adult subjects (42 males and 8 females) with an age range from 21 to 66years complaining of snoring and obstructive sleep apnea underwent nasopharyngoscopy to assess airway during the Müller maneuver while awake and during sleep induced by i.v. propofol infusion 100–150μg/kg/min. comparison between the awake and induced sleep fiberoptic nasoendoscopy findings regarding the degree and shape of airway obstruction at the retropalatal, oropharyngeal and hypopharyngeal levels was done. ResultsThere was statistically significant difference between the two groups regarding the shape of obstruction at the retropalatal and oropharyngeal levels; while there was no statistically significant difference between the two groups regarding the degree of obstruction at the three levels. ConclusionThe drug induced sleep endoscopy was more accurate than the Müller maneuver in assessing the shape of obstruction at the retropalatal and the oropharyngeal level, while it was the same as the Müller maneuver in assessing the degree of obstruction at retropalatal, oropharyngeal and hypopharyngeal levels.