Interventional Drug-Induced Sleep Endoscopy: A novel technique to guide surgical planning for obstructive sleep apnea

Andrew Jacob Victores, Krista Olson, Masayoshi Takashima

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Study Objective: One of the challenges of surgery for obstructive sleep apnea (OSA) is identifying the correct surgical site for each patient. The objective of this study was to use drug-induced sleep endoscopy (DISE) and nasopharyngeal tube (NPT) placement to determine the effect of eliminating palatal collapse on the obstruction seen on other segments of the upper airway. Methods: Forty-one OSA patients were enrolled in this prospective study. All patients had a polysomnogram followed by DISE. DISE findings were recorded and compared with and without placement of a NPT. Obstruction was graded with a scale that incorporates location, severity, and interval of obstruction. Results: Most patients (83%) demonstrated multilevel obstruction on initial DISE. With the nasopharyngeal airway in place, many patients with multilevel obstruction had at least a partial improvement (74%) and some a complete resolution (35%) of collapse (p < 0.05). Reduction in collapse was observed at the lateral walls (86%), epiglottis (55%), and tongue base (50%). NPT placement did not significantly alter upper airway morphology of patients with incomplete palatal obstruction or mild OSA. Conclusions: To our knowledge, this is the first study to evaluate the effect of soft palatal stenting on downstream pharyngeal obstruction during DISE. Our study provides evidence that reducing soft palatal collapse can reduce negative pharyngeal pressure and thereby alleviate other sites of upper airway obstruction. Taken together, these findings provide a means to identify appropriate candidates for isolated palatal surgery and better direct a minimally invasive approach to the surgical management of OSA.

Original languageEnglish (US)
Pages (from-to)169-174
Number of pages6
JournalJournal of Clinical Sleep Medicine
Volume13
Issue number2
DOIs
StatePublished - 2017

Keywords

  • DISE
  • Drug-induced sleep endoscopy
  • Nasopharyngeal tube
  • OSA
  • Obstructive sleep apnea

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

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