The Emerging Role of Drug-Induced Sleep Endoscopy in the Management of Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea is a prevalent sleep disorder characterized by partial or complete obstruction of the upper airway. Continuous positive airway pressure is the first-line therapy for most patients, but compliance is often poor. Alternative treatment options such as mandibular advancement devices, positional therapy and surgical interventions including upper airway stimulation target different levels and patterns of obstruction with varying degrees of success. Drug-induced sleep endoscopy enables visualization of upper airway obstruction under conditions mimicking sleep. In an era of precision medicine, this additional information may facilitate better decision-making when prescribing alternative treatment modalities, with the hope of achieving better compliance and/or success rates. This review discusses the current knowledge and evidence on the role of drug-induced sleep endoscopy in the non-positive airway pressure management of obstructive sleep apnea.

Influence of Lingual Tonsillar Volume in Patients with Obstructive Sleep Apnea

“…The supine arousal index was increased significantly more in the upper half LT volume group than in the lower half LT volume group. When a patient lies in the supine position, gravity affects the LT and narrows the oropharyngeal airway compared with that in the lateral position [22]. Due to this oropharyngeal airway narrowing, arousal in the supine position shows a significant difference between the two LT volume groups.…”

Hypoglossal nerve stimulation for adults with obstructive sleep apnea

“…DISE is required during presurgical evaluation for the Inspire UAS system because of this contraindication, based on early data associating complete concentric collapse with reduced treatment success. 20 Though not a contraindication, the manufacturer cautions against Inspire UAS system use for patients with a body mass index (BMI) greater than 32 kg/m 2 , because of concerns about reduced efficacy noted in an early feasibility study, which led researchers to exclude patients with BMIs over 32 from the pivotal clinical trial conducted for FDA approval. 18,21 In contrast, recommendations for use in Germany include patients with a BMI up to 35 kg/m 2 , based on data from additional studies showing maintained efficacy.…”

“…It helps determine the site(s), degree, and configuration of collapse for a patient with OSA. DISE is required during presurgical evaluation for the Inspire UAS system because of this contraindication, based on early data associating complete concentric collapse with reduced treatment success 20…”

Endoscopia de sueño inducida por medicamentos: técnica y procedimiento.

“…Por otro lado, el tratamiento de primera línea más aceptado a nivel mundial es el uso del dispositivo de presión continua de vía aérea (CPAP, continuous positive airway pressure). No obstante, existen algunos pacientes que no son capaces de tolerar el dispositivo de presión positiva continua de la vía aérea (CPAP, por sus siglas en ingles), por lo cual se han desarrollado alternativas como dispositivos orales, terapia posicional y cirugía de vía aérea (3) . Una correcta evaluación de la vía aérea y un manejo individualizado son claves para la selección del tratamiento y pronóstico (4,5) .…”