Drug-Induced Sleep Endoscopy: Evaluation of a Selection Tool for Treatment Modalities for Obstructive Sleep Apnea

Vroegop, Anneclaire V.; Vanderveken, Olivier M.; Verbraecken, Johan

doi:10.1159/000505584

Cited by 26 publications

(19 citation statements)

References 83 publications

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“…5 Many studies have been published describing patterns of obstruction observed during DISE and associations with baseline OSA severity. 6-9 In addition, there is a growing body of literature describing the impact of DISE on treatment decision making in adult OSA 10-13 and the utility of DISE in predicting surgical outcomes. 14-17…”

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confidence: 99%

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

Baldassari

Lam

Ishman

et al. 2021

Otolaryngol.--head neck surg.

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Objective To develop an expert consensus statement on pediatric drug-induced sleep endoscopy (DISE) that clarifies controversies and offers opportunities for quality improvement. Pediatric DISE was defined as flexible endoscopy to examine the upper airway of a child with obstructive sleep apnea who is sedated and asleep. Methods Development group members with expertise in pediatric DISE followed established guidelines for developing consensus statements. A search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements regarding DISE in children 0 to 18 years old. Topics with significant practice variation and those that would improve the quality of patient care were prioritized. Results The development group identified 59 candidate consensus statements, based on 50 initial proposed topics, that focused on addressing the following high-yield topics: (1) indications and utility, (2) protocol, (3) optimal sedation, (4) grading and interpretation, (5) complications and safety, and (6) outcomes for DISE-directed surgery. After 2 iterations of the Delphi survey and removal of duplicative statements, 26 statements met the criteria for consensus; 11 statements were designated as no consensus. Several areas, such as the role of DISE at the time of adenotonsillectomy, were identified as needing further research. Conclusion Expert consensus was achieved for 26 statements pertaining to indications, protocol, and outcomes for pediatric DISE. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to pediatric DISE.

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confidence: 99%

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

Baldassari

Lam

Ishman

et al. 2021

Otolaryngol.--head neck surg.

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“…In the literature [21,22], it is well reported how DISE can provide a good indication of the chances of success with MAD therapy. For many authors [23,24], DISE is a valid diagnostic and prognostic exam, but it has many limitations:…”

Section: Discussionmentioning

confidence: 99%

Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices

Gasparini

Saponaro

Todaro

et al. 2021

IJERPH

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Purpose: The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. Methods: This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. Results: We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. Conclusion: Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.

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“…Our results showed that for some patients, the NAS worked as well as the OAs. Therefore, we propose that the NAS could be a potential treatment choice for patients with OSAS, because it is important to optimize treatment by trying and combining various methods [33].…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Nasal Airway Stent Therapy for the Treatment of Mild-to-Moderate Obstructive Sleep Apnea Syndrome

et al. 2020

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Background: Patients with obstructive sleep apnea syndrome (OSAS) experience excessive daytime sleepiness and insomnia and they are at risk of developing cardiovascular disease and stroke. Continuous positive airway pressure therapy could improve symptoms and decrease these risks; however, adherence is problematic. Although the oral appliance is another therapeutic option, patient satisfaction is limited and the effect of the nasal airway stent – a new device – remains unclear. Objectives: The aim of this study was to evaluate the effect of NAS therapy in patients with mild-to-moderate OSAS in a prospective, single-arm, interventional pilot study. Method: Patients with mild/moderate sleep apnea (n = 71; Apnea-Hypopnea Index [AHI], 5–20 events/h on polysomnography) were recruited. Sleep-associated events were measured using a portable device (WatchPAT200) pre- and immediately post-treatment and at 1 month follow-up. AHI (including supine and non-supine AHI), Oxygen Desaturation Index (ODI), Respiratory Disturbance Index (RDI), percutaneous oxygen saturation, heart rate, and snore volume were evaluated. Symptoms were assessed using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. Results: NAS use significantly improved AHI, supine AHI, RD, ODI, and snore volume compared to pre-intervention (r = 0.44, 0.48, 0.3, 0.42, and 0.34; p < 0.001, p < 0.001, p = 0.011, p < 0.001, and p = 0.048, respectively). Additionally, 25 and 10% of patients showed complete and partial response for AHI, respectively; these improvements remained significant 1 month later. Pittsburgh Sleep Quality Index scores improved from 6.0 to 5.3 (r = 0.46, p = 0.022). Conclusions: NAS therapy reduced severity and snoring in patients with mild-to-moderate OSAS. Approximately 30% of patients did not tolerate NAS due to side effects.

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Drug-Induced Sleep Endoscopy: Evaluation of a Selection Tool for Treatment Modalities for Obstructive Sleep Apnea

Cited by 26 publications

References 83 publications

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices

The Effectiveness of Nasal Airway Stent Therapy for the Treatment of Mild-to-Moderate Obstructive Sleep Apnea Syndrome

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