Drug Induced Sleep Endoscopy in Obstructive Sleep Apnea

Authors

1 Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran,

2 Department of Othorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran,

3 Department of Psychiatry, School of Medicine, Sleep Clinic of Ebn-e-Sina Hospital, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,

4 Department of Community Medicine, Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran,

5 Department of Pulmonary and Critical Care Medicine, Lung Diseases Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.

Abstract

Background: One of the main challenges of surgical treatment in Obstructive Sleep Apnea (OSA) is identifying the correct site of upper airway obstruction in an individual patient. Drug-Induced Sleep Endoscopy (DISE) in sedated patients with obstructive sleep apnea is the technique of choice for revealing anatomic and dynamic collapsible areas. Materials and Methods: In a prospective cross-sectional study adult patients with OSA documented by polysomnography were evaluated by sleep endoscopy. DISE had been done by an otolaryngologist in the setting of operating room during infusion of propofol and after the start of snoring. Endoscopic findings were recorded and evaluated from the aspect of obstruction level, severity, and multiplicity. Results: Twenty OSA patients (60% men) with mean±SD age of 38.9±9.26 years and mean Body Mass Index (BMI) of 26.57 kg/m2 were included in the study. OSA was severe in 11(55%) and moderate in 5(25%) subjects. Unilevel airway collapse was observed as retropalatal in 4(20%) and retrolingual in 3(15%) subjects. Multilevel collapse had been observed in the other 13(65%) patients. Most patients (65%) had multilevel obstruction especially those with BMI>30 (p <0.05). With increasing BMI, obstruction changed from unilevel to multilevel. None of the subjects showed complications with propofol or endoscopy procedure. Conclusion: Our study showed DISE is safe, easy to perform, and informative in OSA patients. In particular, we observed a significant association between obesity and multilevel upper airway collapse.

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