Awake Endoscopy Research Articles

Treatment Outcomes in Awake Endoscopy With Advanced Programming in Hypoglossal Nerve Stimulation.

Hypoglossal nerve stimulation (HNS) is a treatment option for patients with moderate-to-severe obstructive sleep apnea. In the post-implant period, awake endoscopy with advanced programming (AEAP) can be employed to improve apnea hypopnea index (AHI) reduction and/or patient comfort. This study describes response patterns to HNS after AEAP as well as patient-specific patterns in our patient population. Retrospective evaluation of 17 consecutive patients who underwent AEAP between June 2019 and December 2022. Post-AEAP AHIs were used to create 2 response groups, which facilitated analysis of patient-based characteristics. AHI reporting, deemed non-titration AHI (NT-AHI), is the whole-night AHI resulting from non-titration studies. Chi-squared, Pearson correlation coefficient, and independent samples t-test were used to determine significance deemed as P < .05. Fifteen of 17 patients (88.2%) presented for failed NT-AHI reduction, and 2/17 (11.8%) presented for comfort measures. Eleven patients (65%) showed an improvement in post-AEAP NT-AHI; 6 (35%) patients failed to improve. Four patients with either lateral wall collapse or concentric wall collapse at the tongue base failed to improve NT-AHI compared to a single patient who showed an improved NT-AHI (P = .017). Of the 2 patients who presented with discomfort, patient 1/2 demonstrated improvement in device usage, and patient 2/2 reported improved comfort while maintaining average device usage. AEAP is a powerful tool that offers the ability to identify settings conducive to increased therapy efficacy and improved treatment tolerability. Airway phenotypes are closely correlated with treatment efficacy, and as such, careful anatomical consideration of the upper airway must be performed when titrating therapy. Amongst the different treatment options for obstructive sleep apnea, hypoglossal nerve stimulation has been shown to be effective in positive-airway-pressure intolerant patients. This article explores response patterns to AEAP and highlights the importance of careful anatomical considerations of the upper airway. Level 3.

The disappearing lesion in the cricopharynx: A hypopharyngeal cushion.

A 2-year-old girl presented to our aero-digestive clinic with complaints of dysphagia to solids. On awake endoscopy, a bluish, expansile lesion was noticed. posterior to the arytenoids, which became prominent when crying. During the airway evaluation under general anesthesia, the lesion completely disappeared, revealing a normal posterior cricoid region. Upon closer examination, a small venous malformation was noted in the posterior pharyngeal wall. A diagnosis of a "hypopharyngeal cushion" was made.

Research on drug-induced sleep endoscopy's effect on treatment approaches for obstructive breathing while sleeping

The research aims to investigate how various medications for obstructive breaths during sleep (OBS) are affected by drug-induced sleep endoscopy (DISE).A thorough examination of the literature revealed that treatment suggestions impacted by DISE had been implemented. The percentage change for every research and collapse location was noted. The cumulative level of modifications and related 94 % confidence interval (CI) were estimated. According to the patient's age, the sample size, the DISE method, and the major diagnostic modality used prior to DISE, analysis of subgroups were conducted. These 1 246 patients (68,1 % men, 58,6 % kids, and 77,03 % with a multilevel collapse) were involved in nine trials in all. In 42,69 % of patients (CI, 32,74 to 52,53), the course of treatment altered. The variation in rates increased following awake endoscopy (61,1 % opposed to 43,5 percent following clinical basic examination (CBE) and 40,1 percent opposed to Muller man oeuvre, P = 0,02), CBE, and lateral cephalometry and midazolam-based DISE procedures. Target-controlled infusion is widely used, and randomized studies that compared its efficacy with different methods of diagnosis can be used to examine its therapeutic benefits. The DISE approach can be encouraged by introducing uniform categorization systems of blockage locations.

A Protocolized Approach to Awake Endoscopy With Advanced Programming to Optimize Hypoglossal Nerve Stimulation.

Hypoglossal nerve stimulation is a treatment option for patients with obstructive sleep apnea who are intolerant to positive airway pressure therapy. In the post-implant period, awake endoscopy with advanced programming (AEAP) can be employed to optimize apnea-hypopnea index reduction and/or patient comfort and usage. The report herein describes awake endoscopy with AEAP as a guide to providers involved in post-implant care. The first 5 consecutive patients were reviewed to provide general understanding of outcomes and safety when implementing such a protocolized approach.

1024 A Challenging Inspire Case: All Roads Do Not Necessarily Lead to Rome

Abstract Introduction Hypoglossal nerve stimulation (HNS) for the treatment of obstructive sleep apnea (OSA) in patients who have failed positive airway pressure (PAP) therapy for one reason or the other is now standard of care. Once the device is implanted and activated, voltage to stimulate the nerve has to be titrated over time, ultimately leading to an HNS titration study. There are 4 possible electrode configurations to stimulate different fibers in the nerve that can be employed for treatment. We present a case of a patient who was a challenge with worsening of OSA with Inspire. Report of case(s) A 65-year-old woman with hypertension, and severe OSA, intolerant of positive airway pressure or oral appliances was implanted with Inspire. Post activation, there was symptomatic improvement with reduction of overall apnea-hypopnea index (AHI) from 34 per hour of sleep to 6.3 per hour. However, patient slept exclusively on the sides with evidence of significant residual disease in REM sleep. During subsequent weeks, patent reported inability to restrict position and discomfort and anxiety associated with up titration. Both awake endoscopy and advanced overnight HNS titration were pursued. All 4 electrode configurations were tested during both procedures. With the exception of (minus-plus-minus) configuration, there was worsening of sleep disordered breathing and higher residual AHI of 60 per hour on polysomnography and evidence of poor tongue motion and collapsed velopharynx on awake endoscopy. Inspire settings were readjusted to (minus-plus-minus) configuration with instructions for very slow outpatient uptitration and co-management of anxiety and discomfort with anxiolytics and sleep aids. Conclusion We make two important conclusions from this case. Firstly, although there are established criteria for patient selection for hypoglossal nerve stimulation therapy, certain other factors that impact success which are not as easily defined include the patients’ expectations, tolerance of discomfort, propensity to anxiety and personality type which impact the ability to successfully titrate voltage with the Inspire device over time. Secondly, as the tongue is a complex muscle, both under titration and over titration may be counterproductive and additionally, electrode configuration may also have varying effects on tongue protrusion and impact success. Support (if any)

0515 Awake endoscopy optimizes tolerance and effectiveness of hypoglossal nerve stimulation

Abstract Introduction Hypoglossal nerve stimulation(HGNS) which has been available and FDA approved since 2014 in the US may allow for effective treatment of obstructive sleep apnea(OSA) in patients without concentric collapse on Drug induced Sleep Endoscopy and other clinical parameters who have failed CPAP. Tolerance of the stimulation parameters may be problematic in a subset of patients not allowing them to adhere to the therapy. Although there are not currently clinically authoritative studies regarding the role of awake endoscopy in management of such patients, visualizing what comfortable settings that allow for effective tongue protrusion while awake potentially allowing for effective treatment of upper airway obstruction in the office setting might serve as a surrogate for ensuring optimization of such treatment during patients' sleep and this is a retrospective review of such patients at Tufts Medical Center in Boston MA. Methods A retrospective chart review of patients who were implanted with a HGNS device (Inspire TM) who did not tolerate therapy and proceeded to awake endoscopy to optimize therapy settings that allowed tolerance or comfort of stimulation were analyzed. Patients who had HGNS and awake endoscopy as part of clinical assessment at any time during the course of their clinical evaluations were included in the review. Results Out of 129 patients implanted at Tufts Medical Center in Boston, MA, 13 such patients (Approximately 10 % of the total number of HGNS implanted patients) proceeded to awake endoscopy to optimize therapy as noted above. A subset of these patients had improved adherence to therapy and treatment of OSA with HGNS therapy subsequently to such management. Conclusion A subset of patients may remain adherent to HGNS therapy after strategically performing awake endoscopy for ensuring comfort and adequacy of tongue protrusion during awake endoscopy in the outpatient setting. This retrospective review indicates that awake endoscopy may optimize tolerance and adherence of HGNS therapy for treatment of OSA in selected patients. Support (if any) None

Impact of Upper Airway Characteristics on Disease Severity and CPAP Therapy in Chinese Patients With OSA: An Observational Retrospective Study.

ObjectiveThe characteristics of the upper airway (UA) are important for the evaluation and treatment of obstructive sleep apnea (OSA). This study aimed to investigate the association of UA characteristics with OSA severity, titration pressure, and initiation of and 3-month compliance with continuous positive airway pressure (CPAP).MethodsThis retrospective study included consecutive patients examined using a semi-quantitative UA evaluation system (combination with physical examination and awake endoscopy) during 2008–2018 at the Department of Respiratory and Critical Care Medicine, Peking University First Hospital. First, the differences in UA characteristics were compared between patients with simple snorers and mild OSA and those with moderate-to-severe OSA. Then, the effect of UA characteristics on the initiation to CPAP therapy and 3-month adherence to CPAP was conducted.ResultsOverall, 1,002 patients were included, including 276 simple snorers and patients in the mild OSA group [apnea-hypopnea index (AHI) <15] and 726 patients in the moderate-to-severe OSA group (AHI ≥15). Tongue base hypertrophy, tonsillar hypertrophy, mandibular recession, neck circumstance, and body mass index (BMI) were independent risk factors for moderate-to-severe OSA. Among those patients, 119 patients underwent CPAP titration in the sleep lab. The CPAP pressures in patients with thick and long uvulas, tonsillar hypertrophy, lateral pharyngeal wall stenosis, and tongue hypertrophy were higher than those of the control group (P < 0.05, respectively). The logistic regression analysis showed that nasal turbinate hypertrophy, mandibular retrusion, and positive Müller maneuver in the retropalate and retroglottal regions were independent predictors for the initiation of home CPAP treatment.ConclusionMultisite narrowing and function collapse of the UA are important factors affecting OSA severity, CPAP titration pressure, and the initiation of home CPAP therapy. Clinical evaluation with awake endoscopy is a safe and effective way for the assessment of patients with OSA in internal medicine.

819 A RARE CASE OF RESPIRATORY SENSE LEAD DYSFUNCTION IN A PATIENT WITH A HYPOGLOSSAL NERVE STIMULATOR

Abstract Introduction In patients with moderate to severe obstructive sleep apnea (OSA) who are intolerant to PAP therapy, hypoglossal nerve stimulation (HGNS) is being increasingly considered as alternative treatment. Implantation involves placing cuff electrodes on inclusion branches of the hypoglossal nerve and a respiratory effort-sensing lead which is placed between the right intercostal muscle layers. These are connected to the implantable pulse generator which usually sits in a right infraclavicular pocket. Report of case(s) A 49-year-old male with severe OSA (AHI 30.8/hour) was implanted with a HGNS two years ago with successful activation a month later. He successfully up titrated his amplitude to the maximum stimulation level within his set range (0.9v – 1.7v). He underwent HGNS titration with AHI reduction to 13.9/hour at 2.1 volts and given a new higher range of 1.5 to 2.5 volts. This was accompanied by reduction in snoring, witnessed apneas and associated arousals with more consolidated sleep and improvement in his Epworth sleepiness score to 3 from 12 as noted prior to HGNS. The patient continued to up titrate over the next six months within his new range to 2.4 volts, when he reported increased sensitivity and intolerance at every stimulation level with recurrence of snoring and daytime sleepiness. He underwent interrogation of his device with subsequent awake endoscopy and change to his electrode configuration with a new lower range of 1.0 to 2.0 volts. However, he continued to have the same complaints. A second interrogation revealed increased impedance within the circuit of the respiratory sensing lead which was reproducible. The patient underwent sensing lead replacement in the operating room. He has since been able to increase stimulation levels without complaints and improvement in his OSA symptoms and is scheduled to have a follow-up hone sleep test (HST). Conclusion This case illustrates the importance of a structured approach in the evaluation of a reduced tolerance to HGNS. This includes assessing adherence, interrogation of the device’s circuitry, evaluating electrode configurations, stimulation thresholds with consideration for awake endoscopy. Repeating this process may be necessary to detect rare or delayed mechanical problems that may occur over time with HGNS. Support (if any):

818 A Ghost from the Past: Unmasked Insomnia Affecting Hypoglossal Nerve Stimulation Therapy Adherence

Abstract Introduction Hypoglossal nerve stimulation (HNS) is an efficacious option for treating moderate to severe obstructive sleep apnea (OSA). However, there is sparse evidence regarding tolerance and adherence to HNS therapy in patients with a diagnosis of insomnia. Report of case(s) A 57-year-old man with well-controlled depression presented for evaluation for HNS therapy. He had been diagnosed with moderate OSA with an apnea-hypopnea index of 22/hour, intolerant of continuous positive airway pressure and mandibular advancement device. He underwent uvulopalatopharyngoplasty without significant improvement. At the time of initial evaluation, he denied history of insomnia and prior sleep aid use. He subsequently underwent successful HNS device implantation and activation. One week after HNS initiation, the patient reported new symptoms of significant difficulty with sleep onset and inability to fall back asleep, which was worse than his untreated OSA symptoms. Device interrogation did not reveal any hardware problems. Adjustments to start delay, pause time and device configuration with awake endoscopy did not improve tolerance. Subsequently, the patient disclosed a remote history of insomnia, which was treated with multiple hypnotics in addition to cognitive-behavioral therapy for insomnia (CBTi) and had resolved. He was diagnosed with recurrent chronic insomnia, for which eszopiclone was initiated without significant improvement. He eventually agreed to CBTi, with partial improvement in device tolerance and improvement in insomnia symptoms. Conclusion This case highlights that HNS therapy adherence can be affected by prior history of, or a current diagnosis of insomnia. Our patient had a predisposition for insomnia that was well controlled prior to HNS therapy initiation. The onset of recurrent insomnia with HNS activation suggests that HNS was a precipitating factor for his now chronic insomnia. Although there is insufficient evidence to suggest whether history of insomnia should affect the decision to initiate HNS therapy, this case illustrates the importance of screening for insomnia at pre-implant evaluation. Our center is now routinely screening for a history of insomnia to identify patients who may benefit from treatment prior to HNS implantation. Larger studies are needed to explore a possible relationship between insomnia and HNS adherence. Support (if any):

Comparison and intervention of differences in upper airway obstruction in children with OSAS between awake and asleep

Objective:Drug induced sleep endoscopy（DISE） is a useful tool to locate the upper airway obstructions in patients with obstructive sleep apnea syndrome（OSAS）. The goal of our research was to compare the sites, degree and patterns of upper airway obstruction detected by DISE versus endoscopy in awake children. The benefit of DISE-mediated upper airway surgery in pediatric OSAS was evaluated. Method:This is a retrospective case series of children with OSAS who had adenoid hypertrophy（the area where adenoids block the postnaris ≥2/3） and tonsils ≤2 degrees（Friedman classification method） . All children underwent sleep monitoring by pulse oximeter before and after operation. DISE was performed before adenoidectomy in DISE group. If obstruction of oropharynx caused by tonsils was found, tonsillectomy was performed at the same time with adenoidectomy. The children who did not undergo DISE before operation were enrolled in the control group. Differences in the degrees and patterns of upper airway obstruction in the DISE group under wakefulness and drug induction were analyzed. Result:The study included 126 children in DISE group, and 200 children in control group. In the DISE group, 56 cases（44.4%） had grade 2 tonsils, and 70 cases（55.6%） had grade 1 tonsils. The patterns of obstruction at velum, tongue base and epiglottis were significantly different in DISE compared with awake endoscopy（P<0.05）; the patterns of obstruction at adenoid and oropharynx were the same in both techniques. There were significant differences in endoscopy scores between the lateral wall of oropharynx and the tongue base（P<0.05）. DISE revealed 57 （45.2%） cases had grade 2 obstruction in the oropharyngeal level. Among them, 44 cases （34.9%） had tonsils at 2 degrees and 13 cases （10.3%） had tonsils at 1 degrees.. There was an improvement in respiratory disturbance index（RDI） and oxygen saturation nadir in the DISE and control groups 1 year after surgery（P<0.05）, and the RDI improvement was better in the DISE group compared with controls（P=0.04）. Conclusion:DISE is an effective method to evaluate the sites and severity of upper airway obstruction in children with OSAS, which was conductive to make the upper airway personalized surgical plan for patients.

Reconfiguration of Upper Airway Stimulation Devices Utilizing Awake Endoscopy

Determine the rates of, reasons for, and effectiveness of device reprogramming utilizing in-office awake endoscopy (AE) in subjects who underwent upper airway stimulation (UAS) surgery. Retrospective chart review. Retrospective chart review at a tertiary care center on patients implanted with UAS devices from November 2015 to July 2018. Sixty patients were implanted with UAS devices. Average pre- and postsurgical total apnea-hypopnea index (AHI) was 40.6 and 4.2 with a 36.4 total AHI reduction. Treatment success based on Sher criteria was observed in 88% of patients. Postoperative titration polysomnography revealed an average functional threshold (FT) and minimum therapeutic amplitude (MTA) of 1.6 and 2.1 V, respectively. A total of 24 AEs were performed in 19 (32%) patients. The most common complaints and reasons for AE were perceived stimulus discomfort (42%), frequent awakenings (32%), and persistent fatigue or non-normalized AHI (21%). After first AE, there was a 0.87 (53%) and 0.93 (45%) V reduction in FT and MTA, respectively. Patients with obstructive sleep apnea continue to succeed with UAS. Fewer than one-third of patients had postsurgical complaints requiring device reconfiguration utilizing AE to assess the pharyngeal airway and optimize device settings. Reduction in the FT and MTA after AE may improve compliance by reducing discomfort and frequent awakenings. Periodic monitoring of patients with implanted UAS devices is necessary to optimize efficacy and maintain patient compliance. 4 Laryngoscope, 130:2494-2498, 2020.

Contribution of drug-induced sleep endoscopy in comparison with awake endoscopy in the management of patients with obstructive sleep apnea syndrome: experience of a French ent sleep center

Contribution of drug-induced sleep endoscopy in comparison with awake endoscopy in the management of patients with obstructive sleep apnea syndrome: experience of a French ent sleep center

The clinical characteristics of patients with an isolate epiglottic collapse

ObjectiveWe analyzed the clinical characteristics of patients with isolated epiglottic collapse (IEC) who had an epiglottic anteroposterior (AP) collapse as the only cause of snoring during drug-induced sleep endoscopy (DISE). MethodsA retrospective analysis of 334 consecutive DISE examinations was performed. Patients who had only epiglottic AP collapse were designated as the IEC group. There were four age- and sex-matched controls for each case, and these patients were designated as the control group. Demographic factors, polysomnography findings, cephalometry, and awake nasopharyngoscopic findings were analyzed. ResultsA total of 11 IEC cases and 44 controls were included. The IEC group had a significantly lower apnea-hypopnea index, higher minimum oxygen saturation level, lower body mass index, and shorter mandible plane to hyoid distance than the controls. However, there were no differences in epiglottic shape or curvature between the two groups. In addition, no IEC was noted during awake endoscopy. Nine (81.8%) epiglottic collapses were resolved with the mouth open and jaw thrust maneuver, which simulated the use of an oral appliance. Six (54.4%) were resolved with head turning, mimicking the lateral sleep position. ConclusionThe clinical characteristics of IEC patients differed from the control group, and IEC could not be identified during awake endoscopy. Therefore, patients with severe snoring but AHI < 5 or mild sleep apnea on polysomnographic findings and DISE, should be considered likely to have IEC. In addition, use of an oral appliance is recommended as an effective treatment for IEC.

The Impact of Drug-induced Sleep Endoscopy on Therapeutic Decisions in Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

ObjectiveThe aim of this study was to assess the ability of drug-induced sleep endoscopy (DISE) to change therapeutic decisions through the identification of obstruction sites in patients with obstructive sleep apnea (OSA).Materials and methodsA systematic review and meta-analysis were conducted concerning studies that reported the impact of DISE on therapeutic recommendations. The percentage of change was collected for each study and per site of the collapse. The pooled rate of change and the respective 95% confidence interval (CI) were computed. Subgroup analysis was performed based on patients’ age, sample size, the applied DISE protocol, and the originally used diagnostic modality before DISE.ResultsIn a total of nine studies, 1247 patients were included (69.2% males, 59.7% children, 78.04% with a multilevel collapse). Therapeutic decisions changed in 43.69% of patients (CI, 33.84 to 53.54). The change rates were significantly higher in adults (54.0% versus 25.9% in children, P = 0.001), midazolam-based DISE protocols (78.4% versus 48.45% for midazolam plus propofol and 33.9% for propofol, P < 0.001), and after awake endoscopy (62.2% as compared to 44.6% after clinical basic examination [CBE], 40.1% after CBE, lateral cephalometry, and Müller maneuver, P = 0.02). Changes at uvular and palatal sites were more frequent in adults and at the tonsils in children.ConclusionThe DISE approach can be promoted via implementing unified classification systems of obstruction sites; the widescale application of target-controlled infusion and its therapeutic benefits can be explored in well-designed randomized studies that compare its efficacy with other diagnostic modalities.

Drug-Induced Sleep Endoscopy: Technique, Indications, Tips and Pitfalls.

Drug-induced sleep endoscopy (DISE) is a diagnostic tool to assess the upper airway of snorers and obstructive sleep apnea patients in conditions that mimic natural sleep. Although DISE appears simple and similar to awake endoscopy, there are many aspects that need to be standardized in order to obtain reliable and reproducible information. In this article, we will recommend how to reliably perform DISE, its indications, and how to obtain and interpret the information of the upper airway.

Prospective Use of Awake Endoscopy for Inspire Activation

Prospective Use of Awake Endoscopy for Inspire Activation

1129 Central Sleep Apnea after Hypoglossal Nerve Stimulation

The emergence of central sleep apnea has been reported when treating obstructive sleep apnea (OSA) with positive airway pressure (PAP), mandibular advanced devices (MAD) or upper airway surgery. We report the emergence of central sleep apnea following OSA treatment with hypoglossal nerve stimulation. A 61 -year-old male with a history of obesity (BMI 31.41) was diagnosed with moderate OSA (REI 27e/hr.). PAP therapy was attempted but not tolerated. An MAD did not improve his symptoms and a repeat portable sleep study with MAD continued to show an REI of 48.8e/hr. with obstructive and central events identified. (49 central apneas, 219 obstructive apneas, 36 hypopneas). A hypoglossal nerve stimulator was implanted after a drug induced endoscopy deemed him an appropriate candidate. Following activation, he completed an in-lab voltage titration up to (+-+) 1.2 V, however residual obstructive and central apneas were observed (AHI 24.71e/hr., 18 central apneas, 3 obstructive apneas, 124 hypopneas) with appearance of Cheyne-Stokes breathing. A follow up portable sleep study a month later continued to show obstructive and central events with an overall REI of 45e/hr. (25 central apneas, 119 obstructive apneas, 74 hypopneas). An awake endoscopy with advanced programming was performed which noted good response to stimulation at the tongue base, however poor response at the soft palate. His configuration was changed to (---) 0.6–1.6V. Follow up PSG titration with new settings demonstrated good control of OSA with an AHI of 2.08/hr. at 1V. Our patient developed central apneic events following implantation of a hypoglossal nerve stimulator for the treatment of obstructive sleep apnea. The pathophysiology behind this phenomenon may be explained by: 1) An unresolved obstruction which may have led to microarousals and overshoot of PaCO2 reduction below the apneic threshold during sleep. 2) Some patients with severe OSA may have an elevated loop gain which may be unmasked after inspiratory flow limitation is relieved, leading to central apneic events. These events eventually may disappear with continuous OSA treatment and eventual resetting of CO2 receptors. In our patient, central apneas resolved following advanced programming which optimized upper airway patency.

Diagnosing Tongue Base Obstruction in Pierre Robin Sequence Infants: Sleep vs Awake Endoscopy.

To investigate whether awake endoscopy can diagnose base-of-tongue obstruction as reliably as sleep endoscopy in infants with Pierre Robin sequence (PRS). The study was retrospective with the clinicians blinded to patient identity. Endoscopy findings were assessed and measured by the performing pediatric otolaryngologist. Tertiary care children's hospital. All infants with PRS managed between January 2005 and July 2015 were included. There were 141 patients, of which 35 underwent both awake endoscopy (AE) and drug-induced sleep endoscopy (DISE). Bedside AE and DISE in the operating room. Presence of moderate or severe base-of-tongue collapse was assessed. Sensitivity, specificity, and positive likelihood ratio of AE findings as well as intertest differences between AE and DISE were calculated. AE had 50.0% sensitivity (95% confidence interval [CI] 27.2%-72.8%) and 86.7% specificity (95% CI 59.5%-98.3%) for detecting base-of-tongue obstruction compared to DISE; false negative rate was 50.0% (n = 10). Positive likelihood ratio was 3.75 (CI 0.96-14.65). Compared to AE, DISE demonstrated significantly more cases of base-of-tongue obstruction ( P = .039). Bedside AE has low sensitivity for detecting base-of-tongue collapse in infants with PRS. Because of the substantial false negative rate, AE may not be a reliable diagnostic modality for ruling out base-of-tongue obstruction in this susceptible population. DISE may be indicated in high-risk patients to avoid underdiagnosing upper airway obstruction.

Incidence of Lingual Tonsil Hypertrophy in Adults with and without Obstructive Sleep Apnea.

Objectives To characterize the incidence of lingual tonsil hypertrophy (LTH) in adults with and without obstructive sleep apnea (OSA) and to determine any potential correlation between them. Study Design Retrospective chart review. Setting Single-center database, September 2016 to April 2017. Subject and Methods Lingual tonsil grade (LTG) determined by awake endoscopy was collected as well as other physical examination findings, such as Friedman tongue position, palatine tonsil size, and neck circumference. STOP-BANG scores and polysomnography data were collected to characterize OSA. Incidence of clinically meaningful LTH (defined as LTG 3 and LTG 4) was compared between OSA and non-OSA groups. Results Ninety-three patient charts were studied in total. There was no significant difference between patients with and without OSA in the incidence of clinically meaningful LTH (OSA, 13.5%; non-OSA, 14.6%; P = .872). Patients with and without OSA were compared by grade: LTG 1, 13.5% (OSA) vs 35.6% (non-OSA); LTG 2, 73.1% (OSA) vs 48.8% (non-OSA); LTG 3, 13.5% (OSA) vs 14.6% (non-OSA). There were no significant correlations between OSA status and LTG (ρ = 0.190, P = .069). Conclusion The incidence of LTH is uncommon, even among those with OSA, and does not seem to differ between patients with and without OSA. Neck circumference appears to be a better clinical indicator than lingual tonsil tissue for the likelihood of a patient having OSA.

The difference between awake endoscopy and drug induced sleep endoscopy: evaluation of pediatric obstructive sleep apnea

The difference between awake endoscopy and drug induced sleep endoscopy: evaluation of pediatric obstructive sleep apnea