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Snoring and Drug-Induced Sleep Endoscopy

 

The first step in a successful treatment for snoring is to accurately diagnose the source of airway obstruction. This allows for targeted treatment. Drug-induced sleep endoscopy involves sedation administered by an anesthesiologist. Then, Dr. Zaghi will insert a flexible telescope through one side of the nose. He will then examine the throat and examine specific sites of airway obstruction. After the exam, he will assess the patient’s condition and recommend a treatment plan.

velar collapse is seen during sleep endoscopy

A study in which the velar collapse was observed during sleep endoscopy found that 58.8% of patients with NSE also had the lateral wall and epiglottis collapsed. Similar results were reported in drug-induced sleep endoscopy. Collapses were most common at the base of the soft palate, followed by the hypopharynx, and the oropharynx.

The findings from both methods are consistent, suggesting that drug-induced sleep endoscopy is an effective way to detect the obstruction site. However, it should be noted that drug-induced sleep endoscopy is still an early phase for clinical applications. Further research is required to determine the reliability of the drug-induced approach in predicting surgical outcomes. In the meantime, it is an effective tool for monitoring and analyzing airway obstruction in patients suffering from OSA.
Airway observations during drug-induced sleep endoscopy are valid representations of natural sleep

In order to determine whether drug-induced sleep endoscopy (DISE) is a valid representation of natural sleep, researchers analyzed 37 video recordings of patients with obstructive sleep apnea. Patients were categorized into three groups based on the type of collapse: velar collapse (58.8%), tongue base (43.2%), and lateral wall (29.9%). Collapse was most common in the soft palate, hypopharynx, and oropharynx.

The use of drug-induced sleep endoscopy in the diagnosis of OSA has two main goals. The first is to validate the airway collapse pattern by developing a model for it. Sensors will be placed in subjects’ upper airways during DISE and during in-lab sleep studies. The data from both studies will be compared, and airway observations during DISE will be used to develop an aerodynamic model of natural sleep.

The second goal of DISE is to improve the quality of data gathered by analyzing the results of polysomnography. While the data from DISE are generally considered valid, the accuracy of the measurements may vary with different types of drug treatments. As with PSG, data from a DISE study must be compared with the results from an in-office sleep study, enabling the use of DISE in the diagnosis of OSA.

Use of nasopharyngeal tube during drug-induced sleep endoscopy

During drug-induced sleep endoscopy, a flexible laryngoscope is passed through the patient’s nose to evaluate the airway and determine any obstructions. These images can be documented for surgical management. The procedure has shown significant statistical promise and safety, validity, and inter/intra-rater reliability. It also has the potential to treat patients with snoring.

The technique is performed under sedation, which is administered in the operating room. The doctor then passes a flexible telescope through the patient’s nose to assess the throat, tongue, and palate. In the study, Dr. Kezirian performed a procedure on patients who had fasted for a day before the procedure to minimize the risks of aspiration and regurgitation. Prior to the procedure, the patients were administered atropine and a topical anesthetic to both nostrils. During the procedure, patients were positioned in a supine position on the operating table. This position mimicked their home sleeping habits.

A patient with OSA who has been diagnosed with OSA should undergo DISE via propofol. During DISE, a physician can examine the patient’s airway under light sedation to identify if he or she is experiencing any signs of OSA. This procedure complements a complete head-and-neck exam and awake endoscopy. The technique is contraindicated for pregnant patients, those who have a known propofol allergy, and patients with significant nasal obstruction.

Comparison between natural and drug-induced sleep in patients with OSA

The American Sleep Association has developed a method to compare the effects of drug-induced and natural sleep on the symptoms and blood oxygen levels of OSA patients. This method is called eight-channel polygraphy, and involves the use of an actometer, SpO2, HR, and a Flow cannula sensor. The patient is monitored while asleep, but the results should be interpreted in terms of the patients’ overall health and the severity of their symptoms.

The study is a prospective, cross-sectional study that will recruit patients with moderate-to-severe OSA. The study’s inclusion criteria are age above 18 years and a total AHI of at least 5. Patients will undergo in-lab polysomnography in the supine and non-supine positions. The researchers will perform the NSE and DISE separately. The sedation agents will be chosen to mimic natural sleep as closely as possible. These two methods will reveal whether any obstruction is present in the esophagus, and if so, what sites. Excessive collapsibility may lead to excessive surgical intervention.