Awake versus sleep endoscopy: personal experience in 250 OSAHS patients

Abstract

Identifying the site of obstruction and the pattern of airway change during sleep are the key points essential to guide surgical treatment decision making for Obstructive Sleep Apnoea-Hypopnoea Syndrome in adults. In this investigation, 250 cases were retrospectively analyzed in order to compare the pharyngolaryngeal endoscopic findings detected in the awake state, with those obtained in drug-induced sedation, by means of the Sleep Endoscopy technique. All endoscopic findings have been classified according to the semi-quantitative NOH staging. The awake and sedation NOH resulted identical in 25% of the cases only, while the discrepancies involved the oropharyngeal and hypopharyngeal sites, respectively in about 33% and 50% of the patients. The laryngeal obstructive role detected during sedation in almost 33% of the cases was both unforeseen and relevant, with all the consequent implications in the treatment choices particularly for the surgical cases.

Keywords: OSAHS; Sleep endoscopy; Snoring.

Figures

Fig. 1

NOH Mismatch – discrepancy rates on Oropharyngeal (O) and Hypopharyngeal (H) findings.

Fig. 2

Laryngeal involvement during sedation – obstruction frameworks.