Novel Intraoral Negative Airway Pressure in Drug-Induced Sleep Endoscopy with Target-Controlled Infusion

Kuo, Yu-Hsuan; Liu, Tien-Jen; Chiu, Feng-Hsiang; Chang, Yi; Lin, Chia‐Mo; Jacobowitz, Ofer; Hsu, Ying-Shuo

doi:10.2147/nss.s327770

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…That is, the integration of various conservative treatments, such as OA, positional therapy, intermittent negative airway pressure, weight control, and several kinds of surgical treatments, may effectively treat OSA, especially CCC. [19][20][21] In our study, 32 patients (39%) had positional OSA. Our study found that upper airway patency improved in a proportion of patients during head rotation or with OA use, and some patients did not improve.…”

Section: Discussionmentioning

confidence: 48%

“…Therefore, we can use these DISE modification findings to adjust our future surgery and treatment protocol. That is, the integration of various conservative treatments, such as OA, positional therapy, intermittent negative airway pressure, weight control, and several kinds of surgical treatments, may effectively treat OSA, especially CCC 19‐21 …”

Section: Discussionmentioning

confidence: 99%

“…Informed consent was obtained from the patients before the exam. The overnight standard PSG or unattended home sleep apnea study was performed and scored in accordance with the American Academy of Sleep Medicine's 2012 definitions 21 …”

Section: Methodsmentioning

confidence: 99%

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Upper Airway Surgery or Weight Control? Modified Drug‐Induced Sleep Endoscopy for Obstructive Sleep Apnea

Lin

Wang

Kuo

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo identify the value of head rotation in the supine position and oral appliance (OA) use in drug‐induced sleep endoscopy (DISE).Study DesignEighty‐three sleep apnea adults undergoing target‐controlled infusion‐DISE (TCI‐DISE) were recruited from a tertiary academic medical center.SettingDuring DISE, 4 positions were utilized: supine position (position 1), head rotation (position 2), mandibular advancement using an OA (position 3), and head rotation with an OA (position 4).MethodsPolysomnography (PSG) data and anthropometric variables during DISE were analyzed.ResultsEighty‐three patients (65 men and 18 women; mean [standard deviation, SD], 48.5 [11.0] years) who underwent PSG and TCI‐DISE were included. The mean (SD) apnea–hypopnea index (AHI) was 35.5 (22.4) events/h. Twenty‐three patients had persistent complete concentric velopharyngeal collapse in the supine position, even with concurrent head rotation and OA (position 4). Their mean (SD) AHI was 54.7 (24.6) events/h, significantly higher than that of the 60 patients without such collapse in position 4 (p < .001). Their mean (SD) body mass index (BMI) was 29.0 (4.1) kg/m2, also significantly higher (p = .005). After adjustment for age, BMI, tonsil size, and tongue position, the degree of velum and tongue base obstruction was significantly associated with sleep apnea severity in positions 2, 3, and 4.ConclusionWe showed the feasibility, safety, and usefulness of using simple edge‐to‐edge, reusable OA in DISE. Patients who are not responsive to head rotation and OA during TCI‐DISE may need upper airway surgery and/or weight control.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

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Upper Airway Surgery or Weight Control? Modified Drug‐Induced Sleep Endoscopy for Obstructive Sleep Apnea

Lin

Wang

Kuo

et al. 2023

Otolaryngol.--head neck surg.

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Expiratory Velopharyngeal Obstruction: Sleep Endoscopy‐Guided Treatment Strategies to Prevent Oral Breathing During Sleep

Hsu,

Ke,

Kuo

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveObstructive sleep apnea (OSA) is a prevalent disorder, with oral breathing influencing its severity. Expiratory velopharyngeal obstruction (EVO), observed during drug‐induced sleep endoscopy (DISE), may contribute to oral breathing in OSA patients. EVO results in obstruction between the pharynx and nasal cavity during expiration. This study aims to identify factors associated with positive EVO during DISE.Study DesignCase series.SettingTertiary Medical Center.MethodsSeventy‐two OSA patients underwent clinical evaluation, polysomnography, and DISE, utilizing interventions like intraoral negative airway pressure (iNAP), mouth closure, and oral appliances (OAs) in supine positions with head rotation. The findings, classified under velopharynx, oropharynx, tongue base, epiglottis, included the presence of EVO.ResultsThe results demonstrated that interventions including mouth closure and iNAP were associated with increased observation of EVO (43.1% and 34.7%) compared to OA (20.1%). However, head rotation was associated with decreased presence of EVO during DISE compare to supine (26% vs 35.8%). Noticeably, per 1 year increase of age was associated with an increased odds of EVO (odds ratio: 1.03, 95% confidence interval: 1.01‐1.06). However, no other baseline characteristics were significantly associated the odds of EVO.ConclusionOur study reveals the effectiveness of head rotation and OA in reducing EVO and improving mouth breathing in OSA patients, offering valuable insights for future treatment strategies.

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Advances in Alternate, Non-PAP, Non-surgical Therapies in the Treatment of Obstructive Sleep Apnea

Hunasikatti,

Pandi-Perumal,

BaHammam

2023

Progress in Sleep Research

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Novel Intraoral Negative Airway Pressure in Drug-Induced Sleep Endoscopy with Target-Controlled Infusion

Cited by 4 publications

References 37 publications

Upper Airway Surgery or Weight Control? Modified Drug‐Induced Sleep Endoscopy for Obstructive Sleep Apnea

Upper Airway Surgery or Weight Control? Modified Drug‐Induced Sleep Endoscopy for Obstructive Sleep Apnea

Expiratory Velopharyngeal Obstruction: Sleep Endoscopy‐Guided Treatment Strategies to Prevent Oral Breathing During Sleep

Advances in Alternate, Non-PAP, Non-surgical Therapies in the Treatment of Obstructive Sleep Apnea

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