Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction?

Abstract

The objective of the study is to assess the correlation between outpatient department (OPD) assessment and sleep nasendoscopy (SNE) in treatment planning for sleep related breathing disorders. The study design includes a blinded, cohort study comparing the treatment prediction based on OPD clinical evaluation with SNE in consecutive, adult patients by a single clinician with a specialist interest in snoring related disorders. Patients with moderate to severe obstructive sleep apnoea and those who had undergone previous treatment were excluded. The study was conducted in Royal National Throat, Nose and Ear Hospital, London and Queen's Hospital, Romford. Ninety-four patients were recruited as participants for the study. The main outcome measures include site of obstruction and treatment planning. The results show no significant correlation between the two groups with SNE recommending less surgical intervention and a choice of surgical and non-surgical management in greater number of patients. In conclusion, even in experienced hands, clinical prediction is significantly modified by SNE findings. The addition of SNE to the diagnostic pathway, to assess the three-dimensional dynamic anatomy of the upper airway, provides a valuable adjunct to the OPD assessment of upper airway collapse. This affords the clinician a greater accuracy of diagnosis and the patient a more focussed management strategy with increased choice of modality of treatment.

Drug-induced sleep endoscopy: conventional versus target controlled infusion techniques—a randomized controlled study

“…It is argued in literature that the sedation-induced sleep does not correlate well with natural sleep. Sedation may significantly alter upper airways' dynamics during apneic events; the excessive muscle relaxation can cause falsepositive patterns of upper airways' collapse; finally, sleep endoscopy may have a significant interobserver variation between otolaryngologist and anesthesiologist, mainly because there are no standardized sedation protocols and randomized clinical trials [12][13][14][15][16][17].…”

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

“…During DISE, the level (palate, oropharynx, tongue base, hypopharynx/epiglottis), the direction (anteroposterior [AP], concentric, lateral), and degree of upper airway collapse (none, partial, or complete) were scored in a standard fashion. [22][23][24][25][26] The palate is defined as the particular portion of the upper airway at the level of the soft palate and uvula, while the oropharynx is defined by the pharyngeal region at the levels of the tonsils (above the tongue base). The tongue base is defined as the retroglossal area, and the hypopharynx is defined as the upper airway region below the tongue base, including of the tip of the epiglottis.…”

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

“…[2][3][4] Various sedation methods have been used to allow for the performance of DISE. Roblin introduced target-controlled infusion (TCI) of propofol to DISE to allow for better control of the sedation level.…”