Technique and Preliminary Analysis of Drug-Induced Sleep Endoscopy With Online Polygraphic Cardiorespiratory Monitoring in Patients With Obstructive Sleep Apnea Syndrome

Gobbi, Riccardo Gomes; Baiardi, Simone; Mondini, Susanna; Cerritelli, Luca; Piccin, Ottavio; Scaramuzzino, G; Milano, Francesca; Melotti, Rita Maria; F, Mordini; Pirodda, Antonio; Cirignotta, Fabio; Sorrenti, Giovanni

doi:10.1001/jamaoto.2016.3964

Cited by 21 publications

(17 citation statements)

References 18 publications

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“…Our patients had an elevated median AHI compared to published norms for children, 27 which supports existing data that preterm infants are more likely to have SDB. 5,6,28 This may be multifactorial, including upper airway obstruction 29 and/or chronic lung parenchymal involvement with low pulmonary reserve. Our patients also had an elevated mean ETCO 2 , which could result from a combination of airway obstruction and ventilation perfusion mismatch secondary to BPD.…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea

Bandyopadhyay

Harmon

Slaven

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Neurocognitive deficits have been shown in school-aged children with sleep apnea. The effect of obstructive sleep apnea (OSA) on the neurodevelopmental outcome of preterm infants is unknown. Methods: A retrospective chart review was performed for all preterm infants (< 37 weeks) who had neonatal polysomnography (PSG) and completed neurodevelopmental assessment with the Bayley Scales of Infant and Toddler Development, 3rd Edition, between 2006 to 2015 at Riley Hospital. Exclusion criteria included grade IV intraventricular hemorrhage, tracheostomy, cyanotic heart disease, severe retinopathy of prematurity, craniofacial anomalies, or central and mixed apnea on PSG. Sleep apnea was defined as an apnea-hypopnea index (AHI) > 1 event/h. Regression analyses were performed to find a relationship between PSG parameters and cognitive, language, and motor scores. Results: Fifteen patients (males: n = 10) were eligible for the study. Median postmenstrual age at the time of the PSG was 41 weeks (37-46). Median AHI for the cohort was 17.4 events/h (2.2-41.3). Median cognitive, language, and motor scores were 90 (65-125), 89 (65-121), and 91 (61-112), respectively. Mean end-tidal CO2 (median 47 mm Hg ) negatively correlated with cognitive scores (P = .01) but did not significantly correlate with language or motor scores. AHI was not associated with cognitive, language, or motor scores. Conclusions: The median score for cognitive, language, and motor scores for preterm infants with neonatal OSA were within one standard deviation of the published norm. Mean end-tidal CO2, independent of AHI, may serve as a biomarker for predicting poor cognitive outcome in preterm infants with neonatal OSA. Commentary: A commentary on this article appears in this issue on page 1233. Keywords: obstructive sleep apnea, polysomnography, infant, newborn Citation: Bandyopadhyay A, Harmon H, Slaven JE, Daftary AS. Neurodevelopmental outcomes at two years of age for premature infants diagnosed with neonatal obstructive sleep apnea.

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Section: Discussionmentioning

confidence: 99%

Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea

Bandyopadhyay

Harmon

Slaven

et al. 2017

Journal of Clinical Sleep Medicine

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“…Early work on this topic was reported in 1996 by Sadoka et al, in a study looking at sleep parameters in natural sleep and comparing it during sleep induced by diazepam and concluded that the findings were similar for non-REM sleep (23). More recent novel studies have addressed this problem by comparing respiratory events during DISE using propofol with natural sleep (4,24). They looked at apnea and hypopnea events and also detected some events in keeping with central apneas.…”

Section: Natural Versus Drug Induced Sleepmentioning

confidence: 99%

Drug induced sleep endoscopy: its role in evaluation of the upper airway obstruction and patient selection for surgical and non-surgical treatment

Kotecha

Vito

2018

J. Thorac. Dis.

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Sleep related breathing disorders cause obstruction of the upper airway which can be alleviated by continuous positive airway pressure (CPAP) therapy, oral devices or surgical intervention. Non-surgical treatment modalities are not always accepted by patients and in order to attain successful surgical outcomes, evaluation of the upper airway is necessary to carefully select the patients who would benefit from surgery. There are numerous techniques available to assess the upper airway obstruction and these include imaging, acoustic analysis, pressure transducer recording and endoscopic evaluation. It is essential to note that the nocturnal obstructive upper airway has limited muscle control compared to the tone of the upper airway lumen during wakefulness. Thus, if one were to attempt to identify the anatomical segments contributing to upper airway obstruction in sleep related breathing disorders; it must be borne in mind that evaluation of the airway must be performed if possible when the patient is awake and asleep albeit during drug induced sleep. This fact as such limits the use of imaging techniques for the purpose. Drug induced sleep endoscopy (DISE) was pioneered at Royal National Throat, Nose and Ear Hospital, London in 1990 and initially introduced as sleep nasendoscopy. The nomenclature and the technique has been modified by various Institutions but the core value of this evaluation technique remains similar and extremely useful for identifying the anatomical segment responsible for obstructing the upper airway during sleep in patients with sleep related breathing disorders. There have been numerous controversies that have surrounded this technique but over the last two decades most of these have been addressed and it now remains in the forefront of methods of evaluating the upper airway obstruction. A variety of sedative agents and different grading systems have been described and efforts to unify various aspects of the technique have been made. This article will look at its usefulness and advantages and will discuss some important contributions made to the field of evaluation of the upper airway using DISE.

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“…However, no severe complications have been reported in the DISE literature for children or adults. Complications are predominantly mild and transient, and include desaturation, the need for oxygen supplementation, and sedation instability during the DISE …”

Section: Discussionmentioning

confidence: 99%

Safety and cost of drug‐induced sleep endoscopy outside the operating room

et al. 2019

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Introduction Drug‐induced sleep endoscopy (DISE) is used to assess site of obstruction for patients in a pharmacologically induced sleep‐like state. It is traditionally performed in the operating room (OR), however, no data exists regarding the feasibility of this intervention outside the OR in children. The objective is to compare the safety of DISE performed in the MRI induction room to those performed in the OR. Methods Prospective case‐series of patients undergoing DISE in the MRI induction room (study group) to those assessed in the OR (controls) in a single‐institution pediatric tertiary care center. Consecutive patients undergoing DISE examination for persistent obstructive sleep apnea (OSA) after adenotonsillectomy from September 2016 to September 2017 were included. Results Overall, 118 patients (38 study patients, 80 controls) with a mean age of 10.6 years (95% confidence interval [CI], 9.3–11.9) underwent DISE; 39.8% (47/118) were female. The most frequent comorbidity was cardiac disease (22.0%, 26/118). The mean obstructive apnea‐hypopnea index was 12.2 events/hour (95% CI, 8.8–15.6) for controls and 13.5 events/hour (95% CI, 8.7–18.3) for study patients (P = .76). No major complication or unplanned admissions occurred in either group. Induction time was similar (12 vs. 13 minutes, P = .7) as was total procedure time (12 vs. 14 minutes, P = .3) for procedures performed in both settings. Conclusion There were no significant complications for DISE performed in the OR or the MRI induction room and procedure times were similar. Further assessment of patient outcomes and resource utilization is needed. Level of Evidence 4 Laryngoscope, 130: 2076–2080, 2020

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Technique and Preliminary Analysis of Drug-Induced Sleep Endoscopy With Online Polygraphic Cardiorespiratory Monitoring in Patients With Obstructive Sleep Apnea Syndrome

Cited by 21 publications

References 18 publications

Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea

Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea

Drug induced sleep endoscopy: its role in evaluation of the upper airway obstruction and patient selection for surgical and non-surgical treatment

Safety and cost of drug‐induced sleep endoscopy outside the operating room

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