Drug‐induced sleep endoscopy in sleep‐disordered breathing: Report on 1,249 cases

Vroegop, Anneclaire V.; Vanderveken, Olivier M.; Boudewyns, An; Scholman, Joost; Saldien, Vera; Wouters, Kristien; Braem, M; Heyning, Paul Van de; Hamans, Evert

doi:10.1002/lary.24479

Cited by 214 publications

(230 citation statements)

References 29 publications

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“…It is well known that the probability of a multilevel collapse is significantly associated with the severity of OSA, as higher AHI values are correlated with a higher percentage of multilevel collapse. 25,35,41 This finding might explain the high prevalence of multilevel collapse in our study (91%) given the relatively high overall baseline AHI of 38.5 ± 11.8/h. Upper airway collapse at the level of the palate was the most common level of collapse in this study, with collapse at the level of the tongue base being the second most common (Figure 1).…”

Section: Discussionmentioning

confidence: 68%

Evaluation of Drug-Induced Sleep Endoscopy as a Patient Selection Tool for Implanted Upper Airway Stimulation for Obstructive Sleep Apnea

Vanderveken

Maurer

Hohenhorst

et al. 2013

Journal of Clinical Sleep Medicine

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Section: Discussionmentioning

confidence: 68%

Evaluation of Drug-Induced Sleep Endoscopy as a Patient Selection Tool for Implanted Upper Airway Stimulation for Obstructive Sleep Apnea

Vanderveken

Maurer

Hohenhorst

et al. 2013

Journal of Clinical Sleep Medicine

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284

241

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“…6,7 Furthermore, imaging studies have shown that gravity can affect upper airway soft tissue structures and their relationship with bony enclosures. 8,9 However, the positional effect on pharyngeal structures such as the tongue base and epiglottis was not reported in these studies.…”

Section: Introductionmentioning

confidence: 99%

Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse

Marques

Genta

Sands

et al. 2017

Sleep

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Objectives:In some patients, obstructive sleep apnea (OSA) can be resolved with improvement in pharyngeal patency by sleeping lateral rather than supine, possibly as gravitational effects on the tongue are relieved. Here we tested the hypothesis that the improvement in pharyngeal patency depends on the anatomical structure causing collapse, with patients with tongue-related obstruction and epiglottic collapse exhibiting preferential improvements. Methods: Twenty-four OSA patients underwent upper airway endoscopy during natural sleep to determine the pharyngeal structure associated with obstruction, with simultaneous recordings of airflow and pharyngeal pressure. Patients were grouped into three categories based on supine endoscopy: Tongue-related obstruction (posteriorly located tongue, N = 10), non-tongue related obstruction (collapse due to the palate or lateral walls, N = 8), and epiglottic collapse (N = 6). Improvement in pharyngeal obstruction was quantified using the change in peak inspiratory airflow and minute ventilation lateral versus supine. Results: Contrary to our hypothesis, patients with tongue-related obstruction showed no improvement in airflow, and the tongue remained posteriorly located while lateral. Patients without tongue involvement showed modest improvement in airflow (peak flow increased 0.07 L/s and ventilation increased 1.5 L/min). Epiglottic collapse was virtually abolished with lateral positioning and ventilation increased by 45% compared to supine position. Conclusions: Improvement in pharyngeal patency with sleeping position is structure specific, with profound improvements seen in patients with epiglottic collapse, modest effects in those without tongue involvement and-unexpectedly-no effect in those with tongue-related obstruction. Our data refute the notion that the tongue falls back into the airway during sleep via gravitational influences.

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“…Vroegop et al (Vroegop et al 2014) reported variations in the obstruction area in 1249 patients who underwent DISE study. That study revealed that 68.2% of patients had multiple obstructive areas.…”

Section: Predictors Of Treatment Successmentioning

confidence: 99%

Practical considerations for effective oral appliance use in the treatment of obstructive sleep apnea: a clinical review

Tsuda

Wada

Ando

2017

Sleep Science Practice

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Oral appliance (OA) therapy is a promising alternative to continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA). By holding the mandible in a forward position, an OA keeps the airway open and prevents collapse. The recently revised practice parameters of the American Academy of Sleep Medicine extend the indications for OA therapy, recommending that "sleep physicians consider prescription of an OA for adult patients with OSA who are intolerant of CPAP therapy or prefer alternative therapy." This manuscript reviews the practical considerations for effective OA therapy with a discussion of three factors: patient eligibility for OA therapy, device features, and requirements for OA providers. Identification of patients who are eligible for OA therapy is a key factor because the overall success rate of OA therapy is lower than that of CPAP. Conventional predictive variables have low sensitivity and specificity; however, new tools such as drug-induced sleep endoscopy and single-night polysomnographic OA titration have been developed. Other factors to consider when determining the indications for OA include the patient's oral health, evidence of inadequate treatment for older populations, and the risk of long-term dentofacial side effects. For the second factor, customization of OA features is a key component of treatment success, and no single OA design most effectively improves every situation. Although adjustment of the mandibular position is much more important than device selection, the adjustment procedure has not been standardized. Additionally, a pitfall that tends to be forgotten is the relationship between application of the mandibular position and device selection. Promising new technology has become commercially available in the clinical setting to provide objective adherence monitoring. Finally, the third factor is the availability of enough qualified dentists because sleep medicine is a relatively new and highly multidisciplinary field. Because OSA treatments such as CPAP and OA therapy are generally considered for continuous use, treatments should be carefully planned with attention to multiple aspects. Additionally, because OA therapy requires the cooperation of professionals with different areas of expertise, such as dentists and physicians with various specialties, everyone involved in OA therapy must understand it well.

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Drug‐induced sleep endoscopy in sleep‐disordered breathing: Report on 1,249 cases

Cited by 214 publications

References 29 publications

Evaluation of Drug-Induced Sleep Endoscopy as a Patient Selection Tool for Implanted Upper Airway Stimulation for Obstructive Sleep Apnea

Evaluation of Drug-Induced Sleep Endoscopy as a Patient Selection Tool for Implanted Upper Airway Stimulation for Obstructive Sleep Apnea

Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse

Practical considerations for effective oral appliance use in the treatment of obstructive sleep apnea: a clinical review

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