scholarly journals High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy

2020 ◽  
Vol Volume 12 ◽  
pp. 767-774
Author(s):  
Chen Zhao ◽  
Alonço Viana ◽  
Yifei Ma ◽  
Robson Capasso
Keyword(s):  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Tongue Position

scholarly journals Patogenesis dan diagnosis gangguan napas saat tidur dengan Drug Induce Sleep Endoscopy (DISE)

2018 ◽  
Vol 47 (2) ◽  
pp. 193
Author(s):  
Elvie Zulka Kautzia Rachmawati ◽  
Wresty Arief ◽  
Susyana Tamin ◽  
Rahmanofa Yunizaf ◽  
Fauziah Fardizza
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Upper Airway ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Muller’S Maneuver

Latar belakang: Obstructive sleep apnea (OSA) ialah penyakit kronis yang terjadi akibat episode intermiten sumbatan jalan napas komplit atau sebagian saat tidur. OSA dapat menimbulkan komplikasi seperti hipertensi, diabetes melitus, stroke dan excessive daytime sleepiness yang dapat berakibat fatal. OSA merupakan bagian dari gangguan napas saat tidur. Tujuan: Mengindentifikasi letak atau level dan konfigurasi sumbatan pada saat tidur. Tinjauan pustaka: Cara untuk mendiagnosis OSA adalah nasofaringolaringoskopi dengan Muller`s maneuver, pemeriksaan polisomnography (PSG), dan drug induce sleep endoscopy (DISE). Pemeriksaan PSG merupakan standar baku emas untuk mendapakan nilai apnea-hipopnea index (AHI) yang menentukan derajat OSA. Pemeriksaan untuk mengidentifikasi lokasi sumbatan jalan napas yang menyebabkan peningkatan resistensi aliran udara adalah Muller`s maneuver dan DISE. Pada pemeriksaan DISE, digunakan propofol atau midazolam secara intravena untuk menstimulasi keadaan sumbatan pada saat tidur, dilanjutkan dengan pemeriksaan nasofaringolaringoskopi. Kesimpulan: Pemeriksaan ini merupakan cara yang sangat terpercaya untuk menentukan level sumbatan pada keadaan tidur, sehingga jenis tindakan operasi yang dilakukan menjadi lebih tepat. Kata kunci: Drug induced sleep endoscopy, midazolam, propofol, manuver Muller’s, obstructive sleep apnea, polisomnografi  ABSTRACT Background: Obstructive sleep apnea (OSA) is a common chronic disorder caused by intermittent episodes of complete or partial upper airway obstruction during sleep. It may lead to complications such as hypertension, diabetes mellitus, stroke, as well as excessive daytime sleepiness which can be fatal. OSA is a part of sleep disorder breathing. Purpose: To identify the sites or the levels of obstruction and its configuration. Literature review: Muller’s maneuver upon nasopharyngoscopy, polysomnography (PSG), and drug-induced sleep endoscopy (DISE) are the modalities for diagnosing OSA. Polysomnography is the gold standard examination for OSA, one of the variables; the apnea-hipopnea index (AHI) is used to determine the presence and severity of OSA. Muller’s maneuver and DISE are the examination to identify the sites responsible for increase in airflow resistance. DISE technique uses intravena injection of propofol or midazolam to produce obstruction in a “natural sleep” condition followed by nasopharyngolaryngoscopy examination. Conclusion: DISE is considered as a very reliable means to define the level of obstruction during sleeping, thus could help to determine appropriate surgery. Keywords: Drug induced sleep endoscopy, midazolam, propofol, Muller’s maneuver, obstructive sleep apnea, polisomnography

Concentric vs Anteroposterior-Laterolateral Collapse of the Soft Palate in Patients With Obstructive Sleep Apnea

2021 ◽  
pp. 019459982110268
Author(s):  
Eli Van de Perck ◽  
Clemens Heiser ◽  
Olivier M Vanderveken
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Soft Palate ◽  
Upper Airway ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Therapeutic Consequences ◽  
Complex Anatomy ◽  
Obstructive Sleep ◽  
Polygonal Shape

The presence of complete concentric collapse of the soft palate (CCCp) during drug-induced sleep endoscopy (DISE) has important therapeutic consequences. However, CCCp may present in various, sometimes doubtful, ways due to the complex anatomy of the upper airway. Herein, we aimed to characterize these doubtful variants by reviewing the DISE recordings of patients with obstructive sleep apnea (n = 332). We observed in some individuals that the soft palate collapsed in an anteroposterior-laterolateral (AP-LL) way, producing a polygonal shape that was distinct from CCCp. Patients with this collapse pattern (n = 29) had a smaller neck circumference and less severe obstructive sleep apnea than patients with CCCp (n = 68). The majority of patients with AP-LL collapse (n = 19) were originally diagnosed with CCCp. Based on these findings, AP-LL collapse of the soft palate might represent a distinct DISE phenotype that is easily confounded with CCCp.

scholarly journals Risk factors and clinical prediction formula for the evaluation of obstructive sleep apnea in Asian adults

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246399
Author(s):  
Do-Yang Park ◽  
Ji-Su Kim ◽  
Bumhee Park ◽  
Hyun Jun Kim
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Goodness Of Fit ◽  
Upper Airway ◽  
Physical Exam ◽  
Berlin Questionnaire ◽  
Clinical Prediction ◽  
Obstructive Sleep ◽  
Tongue Position

Obstructive sleep apnea is a highly prevalent cyclic repetitive hypoxia-normoxia respiratory sleep disorder characterized by intermittent upper-airway collapse. It is mainly diagnosed using in-laboratory polysomnography. However, the time-spatial constraints of this procedure limit its application. To overcome these limitations, there have been studies aiming to develop clinical prediction formulas for screening of obstructive sleep apnea using the risk factors for this disorder. However, the applicability of the formula is restricted by the group specific factors included in it. Therefore, we aimed to assess the risk factors for obstructive sleep apnea and develop clinical prediction formulas, which can be used in different situations, for screening and assessing this disorder. We enrolled 3,432 Asian adult participants with suspected obstructive sleep apnea who had successfully undergone in-laboratory polysomnography. All parameters were evaluated using correlation analysis and logistic regression. Among them, age, sex, hypertension, diabetes mellitus, anthropometric factors, Berlin questionnaire and Epworth Sleepiness Scale scores, and anatomical tonsil and tongue position were significantly associated with obstructive sleep apnea. To develop the clinical formulas for obstructive sleep apnea, the participants were divided into the development (n = 2,516) and validation cohorts (n = 916) based on the sleep laboratory visiting date. We developed and selected 13 formulas and divided them into those with and without physical examination based on the ease of application; subsequently, we selected suitable formulas based on the statistical analysis and clinical applicability (formula including physical exam: sensitivity, 0.776; specificity, 0.757; and AUC, 0.835; formula without physical exam: sensitivity, 0.749; specificity, 0.770; and AUC, 0.839). Analysis of the validation cohort with developed formulas showed that these models and formula had sufficient performance and goodness of fit of model. These tools can effectively utilize medical resources for obstructive sleep apnea screening in various situations.

scholarly journals Drug Induced Sleep Endoscopy for Obstructive Sleep Apnea Syndrome: An Initial Experience in a Tertiary Level Centre

2019 ◽  
Vol 41 (3) ◽  
pp. 83-85
Author(s):  
Bashu D Parajuli ◽  
Lokendra Mandal ◽  
Megha Koirala ◽  
Amit S Bhattarai ◽  
Yogesh Neupane ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Anaesthetic Agents ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Drug induced sleep endoscopy (DISE) is a technique of performing endoscopy of the upper airway after inducing sleep by the use of anaesthetic agents in patients suffering from obstructive sleep apnea syndrome (OSAS). The main purpose of DISE is to detect the obstruction or collapse at one or more location in the upper airway, both for the successful diagnosis and management of OSAS. Here we discuss a case of OSAS who underwent DISE under novel anaesthetic agents midazolam and dexmedetomidine.

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