The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnoea syndrome: our personal experience

E DE Corso, A Fiorita, G Rizzotto, G F Mennuni, D Meucci, M Giuliani, M R Marchese, L Levantesi, G Della Marca, G Paludetti, E Scarano, E DE Corso, A Fiorita, G Rizzotto, G F Mennuni, D Meucci, M Giuliani, M R Marchese, L Levantesi, G Della Marca, G Paludetti, E Scarano

Abstract

Nowadays, drug-induced sleep endoscopy (DISE) is performed widely and its validity and reliability has been demonstrated by several studies; in fact, it provides clinical information not available by routine clinical inspection alone. Its safety and utility are promising, but still needs to be improved to reach the level of excellence expected of gold standard tests used in clinical practice. Our study compares the results of clinical and diagnostic evaluation with those of sleep endoscopy, evaluating the correlation between clinical indexes of routine clinical diagnosis and sites of obstruction in terms of number of sites involved, entity of obstruction and pattern of closure. This study consists in a longitudinal prospective evaluation of 138 patients who successfully underwent sleep endoscopy at our institution. Patients were induced to sleep with a low dose of midazolam followed by titration with propofol. Sedation level was monitored using bispectral index monitoring. Our results suggest that the multilevel complete collapse was statistically significantly associated with higher apnoea hypopnea index values. By including partial sites of obstruction greater than 50%, our results also suggest that multilevel collapse remains statistically and significantly associated with higher apnoea hypopnoea index values. Analyzing BMI distribution based on number of sites with complete and partial obstruction there was no significant difference. Finally, analyzing Epworth Sleepiness Score distribution based on number of sites with complete obstruction, there was a statistically significant difference between patients with 3-4 sites of obstruction compared to those with two sites or uni-level obstruction. In conclusion, our data suggest that DISE is safe, easy to perform, valid and reliable, as previously reported. Furthermore, we found a good correlation between DISE findings and clinical characteristics such as AHI and EPS. Consequently, adequate assessment by DISE of all sites of obstruction is very important, not only in patients with low-moderate AHI and EPS, but also in patients with a high AHI or/and high EPS, in particular to plan multilevel surgery that in these latter situations is more demanding since success may be harder to achieve.

Keywords: AHI; BMI; Drug-induced sleep endoscopy; EPS; Obstructive sleep apnoea syndrome.

Figures

Fig. 1.
Fig. 1.
AHI distribution based on the number of sites of complete collapse (a) and complete plus partial collapses greater than 50% (b). The box plots show the median and inter-quartile range and the error bars show the 5th and 95th percentiles. a. 1: one complete site of obstruction of 100%; 2: two complete sites of obstruction of 100%; 3: three complete sites of obstruction of 100%; 4: four complete sites of obstruction of 100%). b. 1: one site of obstruction of 100% or > 50%; 2: two sites of obstruction of 100% and/or > 50%; 3: three sites of obstruction of 100% and/or > 50%; 4: four sites of obstruction of 100% and/or > 50%).
Fig. 1.
Fig. 1.
AHI distribution based on the number of sites of complete collapse (a) and complete plus partial collapses greater than 50% (b). The box plots show the median and inter-quartile range and the error bars show the 5th and 95th percentiles. a. 1: one complete site of obstruction of 100%; 2: two complete sites of obstruction of 100%; 3: three complete sites of obstruction of 100%; 4: four complete sites of obstruction of 100%). b. 1: one site of obstruction of 100% or > 50%; 2: two sites of obstruction of 100% and/or > 50%; 3: three sites of obstruction of 100% and/or > 50%; 4: four sites of obstruction of 100% and/or > 50%).
Fig. 2.
Fig. 2.
BMI distribution based on the number of sites of complete collapse (a) and complete plus partial collapses greater than 50% (b). The box plots show the median and inter-quartile range and the error bars show the 5th and 95th percentiles. a. 1: one complete site of obstruction of 100%; 2: two complete sites of obstruction of 100%; 3: three complete sites of obstruction of 100%; 4: four complete sites of obstruction of 100%). b. 1: one site of obstruction at 100% or > 50%; 2: two sites of obstruction of 100% and/or > 50%; 3: three sites of obstruction of 100% and/or >5 0%; 4: four sites of obstruction of 100% and/or > 50%).
Fig. 2.
Fig. 2.
BMI distribution based on the number of sites of complete collapse (a) and complete plus partial collapses greater than 50% (b). The box plots show the median and inter-quartile range and the error bars show the 5th and 95th percentiles. a. 1: one complete site of obstruction of 100%; 2: two complete sites of obstruction of 100%; 3: three complete sites of obstruction of 100%; 4: four complete sites of obstruction of 100%). b. 1: one site of obstruction at 100% or > 50%; 2: two sites of obstruction of 100% and/or > 50%; 3: three sites of obstruction of 100% and/or >5 0%; 4: four sites of obstruction of 100% and/or > 50%).
Fig. 3.
Fig. 3.
Epworth Sleepiness Score distribution based on the number of sites of complete collapse. The box plots show the median and inter-quartile range and the error bars show the 5th and 95th percentiles. 1: one complete site of obstruction of 100%; 2: two complete sites of obstruction of 100%; 3: three complete sites of obstruction of 100%; 4: four complete sites of obstruction of 100%).
Fig. 4.
Fig. 4.
AHI (a) and BMI (b) in patients with (1) or without (0) concentric complete oropharyngeal collapse.
Fig. 4.
Fig. 4.
AHI (a) and BMI (b) in patients with (1) or without (0) concentric complete oropharyngeal collapse.
Fig. 5.
Fig. 5.
AHI in patients with (1) or without (0) laryngeal site collapse.

References

    1. Campanini A, Canzi P, Vito A, et al. Awake versus sleep endoscopy: personal experience in 250 OSAHS patients. Acta Otorhinolaryngol Ital. 2010;30:70–73.
    1. Croft CB, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci. 1991;16:504–509.
    1. Eichler C, Sommer JU, Stuck BA, et al. Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea? Sleep Breath. 2013;17:63–68.
    1. Vanderveken OM. Drug-induced sleep endoscopy (DISE) for non-CPAP treatment selection in patients with sleep-disordered breathing. Sleep Breath. 2013;17:13–14.
    1. Hong SD, Dhong HJ, Kim HY, et al. Change of obstruction level during drug-induced sleep endoscopy (DISE) according to sedation depth in obstructive sleep apnea. Laryngoscope. 2013 Aug 05; doi: 10.1002/lary.24045.
    1. Vroegop AV, Vanderveken OM, Wouters K, et al. Observer variation in drug-induced sleep endoscopy: experienced versus nonexperienced ear, nose, and throat surgeons. Sleep. 2013;36:947–953.
    1. Gillespie MB, Reddy RP, White DR, et al. A trial of drug-induced sleep endoscopy in the surgical management of sleepdisordered breathing. Laryngoscope. 2013;123:277–282.
    1. Epstein LJ, Kristo D, Strollo PJ, Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–276.
    1. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8:597–619.
    1. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–689.
    1. Kezirian EJ, Hohenhorst W, Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol. 2011;268:1233–1236.
    1. Milano F, Mondini S, Billi MC, et al. The impact of a multidisciplinary approach on response rate of mandibular advancing device therapy in patients with obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital. 2013;33:337–342.
    1. Fusetti M, Fioretti AB, Valenti M, et al. Cardiovascular and metabolic comorbidities in patients with obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital. 2012;32:320–325.
    1. Passali D, Caruso G, Arigliano LC, et al. Database application for patients with obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital. 2012;32:252–255.
    1. Passali FM, Bellussi L, Mazzone S, et al. Predictive role of nasal functionality tests in the evaluation of patients before nocturnal polysomnographic recording. Acta Otorhinolaryngol Ital. 2011;31:103–108.
    1. Piumetto E, Sammartano AM, Meinardi G, et al. Diagnostic and therapeutic iter in paediatric OSAS: personal experience. Acta Otorhinolaryngol Ital. 2011;31:149–153.
    1. Schwab RJ, Pasirstein M, Pierson R, et al. Identification of upper air way anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med. 2003;168:522–530.
    1. Huang Y, White DP, Malhotra A. The impact of anatomic manipulations on pharyngeal collapse: results from a computational model of the normal human upper airway. Chest. 2005;128:1324–1330.
    1. Salamanca F, Costantini F, Bianchi A, et al. Identification of obstructive sites and patterns in obstructive sleep apnoea syndrome by sleep endoscopy in 614 patients. Acta Otorhinolaryngol Ital. 2013;33:261–266.
    1. Bachar G, Nageris B, Feinmesser R, et al. Novel grading system for quantifying upper-airway obstruction on sleep endoscopy. Lung. 2012;190:313–318.
    1. Borek RC, Thaler ER, Kim C, et al. Quantitative airway analysis during drug-induced sleep endoscopy for evaluation of sleep apnea. Laryngoscope. 2012;122:2592–2599.
    1. Abdullah VJ, Wing YK, Hasselt CA. Video sleep nasendoscopy: the Hong Kong experience. Otolaryngol Clin North Am. 2003;36:461–471.
    1. Ravesloot MJ, Vries N. One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope. 2011;121:2710–2716.
    1. Kezirian EJ, Malhotra A, Goldberg AN, et al. Changes in obstructive sleep apnea severity, biomarkers, and quality of life after multilevel surgery. Laryngoscope. Laryngoscope;120:1481–1488.
    1. Kezirian EJ, Goldberg AN. Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based review. Arch Otolaryngol Head Neck Surg. 2006;132:206–213.
    1. Iwanaga K, Hasegawa K, Shibata N, et al. Endoscopic examination of obstructivesleep apnea syndrome patients during drug-induced sleep. Acta Otolaryngol Suppl. 2003;550:36–40.
    1. Babar-Craig H, Rajani NK, Bailey P, et al. Validation of sleep nasendoscopy for assessment of snoring with bispectral index monitoring. Eur Arch Otorhinolaryngol. 2012;269:1277–1279.
    1. Sleigh JW, Andrzejowski J, Steyn-Ross A, et al. The bispectral index: a measure of depth of sleep? Anesth Analg. 1999;88:659–661.
    1. Civelek S, Emre IE, Dizdar D, et al. Comparison of conventional continuous positive airway pressure to continuous positive airway pressure titration performed with sleep endoscopy. Laryngoscope. 2012;122:691–695.
    1. Giarda M, Brucoli M, Arcuri F, et al. Efficacy and safety of maxillomandibular advancement in treatment of obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital. 2013;33:43–46.
    1. Vicini C, Frassineti S, La Pietra MG, et al. Tongue Base Reduction with Thyro-Hyoido-Pexy (TBRTHP) vs. Tongue Base Reduction with Hyo-Epiglottoplasty (TBRHE) in mildsevere OSAHS adult treatment. Preliminary findings from a prospective randomised trial. Acta Otorhinolaryngol Ital. 2010;30:144–148.
    1. Mantovani M, Minetti A, Torretta S, et al. The velo-uvulopharyngeal lift or "roman blinds" technique for treatment of snoring: a preliminary report. Acta Otorhinolaryngol Ital. 2012;32:48–53.
    1. Tarsitano A, Marchetti C. Unusual presentation of obstructive sleep apnoea syndrome due to a giant mandible osteoma: case report and literature review. Acta Otorhinolaryngol Ital. 2013;33:63–66.
    1. Rodriguez-Bruno K, Goldberg AN, McCulloch CE, et al. Test-retest reliability of drug-induced sleep endoscopy. Otolaryngol Head Neck Surg. 2009;140:646–651.
    1. Vito A, Agnoletti V, Berrettini S, et al. Drug-induced sleep endoscopy: conventional versus target controlled infusion techniques - a randomized controlled study. Eur Arch Otorhinolaryngol. 2011;268:457–462.

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