Drug‐Induced Sleep Endoscopy vs Awake Müller’s Maneuver in the Diagnosis of Severe Upper Airway Obstruction

Abstract

Objective To compare fiber-optic nasal endoscopy with Müller's maneuver (FNMM) against drug-induced sleep endoscopy (DISE) in diagnosing the presence of severe level-specific upper airway collapse in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Study Design Case series with chart review. Setting Tertiary care academic center. Subjects and Methods Medical records of all adult patients undergoing diagnostic DISE as part of their surgical evaluation were reviewed. Patients were included if they had undergone FNMM and had documented Friedman tongue position and tonsillar grade prior to DISE. Airway obstruction on both endoscopic procedures was described according to airway level and severity. Severe airway obstruction was defined as >75% collapse on endoscopy. Results Fifty-three patients were included in this study. Fiber-optic nasal endoscopy with Müller's maneuver and DISE did not differ significantly regarding the presence of severe retropalatal airway collapse. There was a statistically significant difference in the incidence of severe retrolingual collapse identified via DISE (84.9% [45/53]) compared with FNMM (35.8% [19/53]; P < .0001). This discrepancy between FNMM and DISE findings was statistically significant in individuals with Friedman I and II tongue positions (FNMM = 16.7%, DISE = 88.9%, P < .0001) and individuals with Friedman III tongue position (FNMM = 31.8%, DISE = 81.8%, P = .002). Patients with Friedman IV showed no significant difference (P = .65) between FNMM (69.2%) and DISE (84.6%). Conclusion This study shows a significant difference between FNMM and DISE in the identification of severe retrolingual collapse. Since the effectiveness of surgical interventions depends largely on the accurate preoperative identification of the site of obstruction, further scrutiny of each diagnostic endoscopic technique is warranted.

Diagnosing Lingual Airway Obstruction Using Nasopharyngeal Tube in OSAHS: Natural Sleep vs Induced Sleep

“…Currently, there are many methods for diagnosing glossopharyngeal obstruction. In addition to a series of commonly used tests while the patient is awake [3,8,9], examinations about localizing the site of obstruction during natural or induced sleep are relatively reliable [4,5,10].…”

“…In addition to a series of commonly applied examinations while awake [8,9], examinations performed during natural or induced sleep are relatively accurate [4,5,10]. Nasopharyngeal tube (NPT) insertion can guarantee the responsibility of excluding the obstruction of the nasal cavity, nasopharyngeal and oropharyngeal airways.…”

Reoperation on patients with obstructive sleep apnea–hypopnea syndrome after failed uvulopalatopharyngoplasty

“…Collapse or obstruction of the nasal, nasopharyngeal, oropharyngeal and glossopharyngeal areas can all be the cause. It has been demonstrated that the oropharyngeal area is the most common site of obstruction in OSAHS [7,8]. As the basic surgery for treating OSAHS, UPPP has been widely applied.…”

“…FTP, CT scan and endoscopic examination were conducted with conventional methods [4,7,8]. NPT-PSG procedures were described shortly as follows [9][10][11].…”

The Utility of Sleep Endoscopy in Adults with Obstructive Sleep Apnea: A Review of the Literature

“…Furthermore, they found tongue base surgery and oral device treatment to have the highest rate of change, whereas the indications for tonsil surgery were comparable between DISE and OPDA. Soares et al [38] retrospectively analyzed 53 patients with OSA and compared OPDA (endoscopy with and without Müller's maneuver) to DISE (with propofol titration of 50/75 mcg/kg/min, the target level of sedation was that of light sleep with arousal to tactile but not vocal stimulation) in diagnosing the presence of severe ([75 % collapse) levelspecific upper airway collapse. OPDA and DISE did not differ significantly regarding the presence of severe retropalatal collapse, but did significantly differ in the incidence of severe retrolingual collapse (DISE 84.9 %, OPDA 35.8 %).…”