Abstract
Surgical success for obstructive sleep apnea (OSA) depends on identifying sites of obstruction in the upper airway. In this study, we investigated sites of obstruction by evaluating dynamic changes in the upper airway using drug-induced sleep computed tomography (DI-SCT) in patients with OSA. Thirty-five adult patients with OSA were prospectively enrolled. Sleep was induced with propofol under light sedation (bispectral index 70–75), and low-dose 320-detector row CT was performed for 10 seconds over a span of 2–3 respiratory cycles with supporting a continuous positive airway pressure model. Most (89%) of the patients had multi-level obstructions. Total obstruction most commonly occurred in the velum (86%), followed by the tongue (57%), oropharyngeal lateral wall (49%), and epiglottis (26%). There were two types of anterior-posterior obstruction of the soft palate, uvular (94%) and velar (6%), and three types of tongue obstruction, upper (30%), lower (37%), and upper plus lower obstruction (33%). DI-SCT is a fast and safe tool to identify simulated sleep airway obstruction in patients with OSA. It provides data on dynamic airway movement in the sagittal view which can be used to differentiate palate and tongue obstructions, and this can be helpful when planning surgery for patients with OSA.
Highlights
Obstructive sleep apnea (OSA) is characterized by repeated partial or complete collapses of the upper airway during sleep[1]
VOTE19 (n = 35) Velopharyngeal obstruction Oropharyngeal LW obstruction Tongue obstruction Epiglottis obstruction purpose of this study was to investigate the feasibility of detecting dynamic upper airway obstructions in patients with obstructive sleep apnea (OSA) using drug-induced sleep computed tomography (DI-SCT)
Thirty-five patients were enrolled in this study (34 men) with a mean age of 40 ± 10 years, a mean body mass index of 27.0 ± 3.3 kg/m2, and a mean apnea-hypopnea index (AHI) of 54.9 ± 28.0 events/hour
Summary
Obstructive sleep apnea (OSA) is characterized by repeated partial or complete collapses of the upper airway during sleep[1]. Surgical effects can be enhanced by weight reduction, adequate sleep position, treatment of nasal allergy, and oropharyngeal muscle training. These non-surgery treatments can be tried before operation. The success of surgery for OSA depends on identifying the sites of obstruction in the upper airway, for which traditional assessment tools performed during wakefulness include physical examination, fiberoptic endoscopy with Muller’s manoeuvre, and imaging studies including cephalometry, videofluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI)[5,6,7,8,9]. Drug-induced sleep endoscopy (DISE) is increasingly being used as a preoperative examination tool for patients undergoing surgery for OSA because it can provide three-dimensional evaluations of changes in the upper airway during pharmacologically-induced sleep[11]. The findings may be helpful in establishing an accurate assessment model for upper airway obstructions in patients with OSA to facilitate surgical planning and improve surgical outcomes
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