Enhanced <scp>drug‐induced</scp> sleep endoscopy: Distinguishing central from obstructive apnea

Cheong, Crystal Sj.; Dedhia, Raj C.; Seay, Everett G; Jara, Sebastian M.; Mora, Jorge; Thaler, Erica R.; Schwartz, Alan R.

doi:10.1002/lary.30517

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…23,24 In our study, we did not find a difference in cardiovascular, neurological, or opiate history between the SCent and non-Scent cohort. In a published case by our group, 25 central sleep apnea with HCSB were uncovered during a DISE exam after an outside preoperative home sleep study. Central sleep apnea (CSA) was later confirmed on an in-laboratory polysomnogram, significantly altering patient management.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Sentinel Central Events (SCent) During Drug‐Induced Sleep Endoscopy

Rodin,

Parekh,

Cai

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveWith the recent addition of airflow and respiratory effort channels, our group has observed central and mixed apnea events during drug‐induced sleep endoscopy (DISE). We measured the frequency and timing of sentinel central and/or mixed events (SCents), as well as assessed for differences in velum, oropharynx, tongue, and epiglottis (VOTE) classification compared to obstructive events.Study DesignProspective single‐cohort study.SettingTertiary Care Academic Medical Center.MethodsPatients underwent DISE between June 2020 and November 2022. Nasal airflow, thoracoabdominal effort belt signals, and videoendoscopy were simultaneously captured. Demographics, sleep study, and DISE data were compared among patients with and without SCents using Student's T tests or χ2 tests.ResultsOn average, the cohort (n = 103) was middle‐aged (53.5 ± 12.1 years), overweight (body mass index of 29.7 ± 5.3 kg/m2), and had severe obstructive sleep apnea (apnea‐hypopnea index of 30.7 ± 18.7 events/h). Forty‐seven patients (46%) were found to have at least 1 SCent. Among those with SCent, 45 (95.7%) transitioned to obstructive pathology after an average of 7.91 ± 2.74 minutes, with at least 95% of patients expected to do so within 12.57 minutes. Twenty‐nine out of 47 patients (61.2% [95% confidence interval: 46.4.9%, 75.5%]) with SCent had meaningful differences between central/mixed and obstructive VOTE scores.ConclusionCentral events were present in almost half of our cohort. At least 95% of patients were expected to transition to obstructive events within 12 to 13 minutes of propofol initiation. In addition, over half of patients demonstrate significantly different VOTE scores between central and obstructive events. These factors should raise awareness of central events and scoring passive apneas during DISE and consider delaying VOTE scoring.

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Section: Discussionmentioning

confidence: 99%

The Prevalence of Sentinel Central Events (SCent) During Drug‐Induced Sleep Endoscopy

Rodin,

Parekh,

Cai

et al. 2024

Otolaryngol.--head neck surg.

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The Whimsical Nature of Airway Obstruction during Drug‐Induced Sleep Endoscopy

Harkins,

Triantafillou,

Seay

et al. 2024

The Laryngoscope

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A 47‐year‐old male patient diagnosed with severe obstructive sleep apnea (OSA) sought alternatives to positive airway pressure, prompting evaluation with drug‐induced sleep endoscopy (DISE). He underwent a specialized DISE with nasal airflow and pharyngeal pressure monitoring. During obstructive apneas, airflow and pressure signals demonstrated dynamic, multilevel upper airway collapse, with shifting sites of airflow obstruction as respiratory effort increased. This case report illustrates how quantitative airflow and pressure measurements can complement the standard DISE exam and aid in surgical decision‐making. Laryngoscope, 2024

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Complete Palatal Obstruction on Drug-Induced Sleep Endoscopy: Just Mouth Breathing?

Harkins,

Rodin,

Phung

et al. 2024

Ear Nose Throat J

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A 70-year-old obese male with moderate obstructive sleep apnea (OSA) sought alternative treatment after failing to tolerate positive airway pressure (PAP) therapy. He underwent drug-induced sleep endoscopy (DISE) with a nasal cannula and oral thermistor to differentiate nasal from oral breathing and a thoracoabdominal belt to track respiratory effort. DISE revealed a complete velum collapse in the anterior-posterior direction, consistent with his awake, supine computed tomography scan, yet the oral thermistor confirmed stable mouth breathing without respiratory distress. A mouth closure maneuver partially reopened the velum and appeared to enlarge the retroglossal airway. This case underscores the importance of evaluating a patient’s primary breathing route during DISE, as standard interpretations of airway collapse may be misleading without this information. Mouth breathing may bypass obstructions at the velum, affecting PAP efficacy and influencing treatment decisions. To address this gap in the VOTE (velum, oropharyngeal lateral walls, tongue base, and epiglottis) classification system, we propose “VM” to denote velum collapse in the context of mouth breathing. This addition could aid in tailoring OSA treatments, particularly for patients who predominantly breathe orally. Our findings advocate for a more patient-specific approach to DISE interpretations, emphasizing the physiological and anatomical aspects of airway collapse.

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Enhanced drug‐induced sleep endoscopy: Distinguishing central from obstructive apnea

Cited by 3 publications

References 5 publications

The Prevalence of Sentinel Central Events (SCent) During Drug‐Induced Sleep Endoscopy

The Prevalence of Sentinel Central Events (SCent) During Drug‐Induced Sleep Endoscopy

The Whimsical Nature of Airway Obstruction during Drug‐Induced Sleep Endoscopy

Complete Palatal Obstruction on Drug-Induced Sleep Endoscopy: Just Mouth Breathing?

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