Sleep and Breathing

, Volume 17, Issue 1, pp 63–68 | Cite as

Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea?

  • Corlette Eichler
  • J. Ulrich Sommer
  • Boris A. Stuck
  • Karl Hörmann
  • Joachim T. Maurer
Original Article

Abstract

Purpose

Success rates of non-ventilation therapies for sleep disordered breathing (SDB) remain hardly acceptable. Drug-induced sleep endoscopy (DISE) tends to show the level and mechanism of obstruction and helps to specify therapy individually. Therefore, increasing success rates are expected. The objective of this study is to detect whether locations of treatment recommendations given after DISE are different to those made after clinical basic ENT (ear, nose, throat) examination (CBE).

Methods

This study included patients with obstructive sleep apnea (OSA) and primary snoring who wish or require an alternative therapy to the gold standard, continuous positive airway pressure (CPAP). After CBE, a theoretical treatment recommendation was given comprising surgery (possible surgical target: soft palate, tonsils, tongue base, epiglottis) and mandibular advancement splints (MAS) or both. A second ENT specialist conducted a DISE and independently recommended a second therapy concept without knowing the first one. A third person compared both theoretical locations of treatment recommendations (CBE vs. DISE).

Results

A total of 97 patients (eight female and 89 male, age 30–85 years, AHI 1.9–88.6/h, body mass index [BMI] 20.3–36.3 kg/m²) received two therapy recommendations. Regarding surgical options only, 63.9% of the examined patients got a different recommendation in at least one of four levels. If MAS was included, a change was found in 78.4% of the patients. Subdivided into each type of intervention, the following changes were found in the therapy concept: 24.7% (n = 24/97) soft palate, 12.4% (n = 12/97) tonsils, 33.0% (n = 32/97) tongue base, 27.8% (n = 27/97) epiglottis, 38.1% (n = 37/97) MAS.

Conclusions

DISE shows a relevant influence on the location of treatment recommendation. Thus, a change in success rates of non-CPAP therapy in OSA and snoring appears possible.

Keywords

Drug-induced sleep endoscopy Obstructive sleep apnea Sleep disordered breathing Mandibular advancement splint 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Lin HC, Friedman M, Chang HW, Gurpinar B (2008) The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope 118(5):902–908PubMedCrossRefGoogle Scholar
  2. 2.
    Hoffstein V (2007) Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 11(1):1–22PubMedCrossRefGoogle Scholar
  3. 3.
    Croft CB, Pringle M (1991) Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 16(5):504–509PubMedCrossRefGoogle Scholar
  4. 4.
    Faber CE, Grymer L (2003) Available techniques for objective assessment of upper airway narrowing in snoring and sleep apnea. Sleep Breath 7(2):77–86PubMedCrossRefGoogle Scholar
  5. 5.
    Abdullah VJ, Wing YK, van Hasselt CA (2003) Video sleep nasendoscopy: the Hong Kong experience. Otolaryngol Clin North Am 36(3):461–471PubMedCrossRefGoogle Scholar
  6. 6.
    Bachar G, Feinmesser R, Shpitzer T, Yaniv E, Nageris B, Eidelman L (2008) Laryngeal and hypopharyngeal obstruction in sleep disordered breathing patients, evaluated by sleep endoscopy. Eur Arch Otorhinolaryngol 265(11):1397–1402PubMedCrossRefGoogle Scholar
  7. 7.
    Hessel N, de Vries N (2003) Results of uvulopalatopharyngoplasty after diagnostic workup with polysomnography and sleep endoscopy: a report of 136 snoring patients. Eur Arch Otorhinolaryngol 260(2):91–95PubMedGoogle Scholar
  8. 8.
    Pringle MB, Croft CB (1993) A grading system for patients with obstructive sleep apnoea–based on sleep nasendoscopy. Clin Otolaryngol Allied Sci 18(6):480–484PubMedCrossRefGoogle Scholar
  9. 9.
    Steinhart H, Kuhn-Lohmann J, Gewalt K, Constantinidis J, Mertzlufft F, Iro H (2000) Upper airway collapsibility in habitual snorers and sleep apneics: evaluation with drug-induced sleep endoscopy. Acta Otolaryngol 120(8):990–994PubMedCrossRefGoogle Scholar
  10. 10.
    Maurer JT, Hormann K (2010) Endoscopy in sleep medicine. HNO 58(4):341–347PubMedCrossRefGoogle Scholar
  11. 11.
    Fischer Y, Neagos A, Gronau S, Rettinger G (2006) Examiner variability of clinical findings in patients with sleep related breathing disorders. Laryngorhinootologie 85(5):338–343PubMedCrossRefGoogle Scholar
  12. 12.
    Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268(8):1233–1236PubMedCrossRefGoogle Scholar
  13. 13.
    Quinn SJ, Daly N, Ellis PD (1995) Observation of the mechanism of snoring using sleep nasendoscopy. Clin Otolaryngol Allied Sci 20(4):360–364PubMedCrossRefGoogle Scholar
  14. 14.
    Camilleri AE, Ramamurthy L, Jones PH (1995) Sleep nasendoscopy: what benefit to the management of snorers? J Laryngol Otol 109(12):1163–1165PubMedCrossRefGoogle Scholar
  15. 15.
    Hewitt R, Dasgupta A, Singh A, Dutta C, Kotecha BT (2009) Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction? Eur Arch Otorhinolaryngol 266(5):691–697PubMedCrossRefGoogle Scholar
  16. 16.
    Johal A, Battagel JM, Kotecha BT (2005) Sleep nasendoscopy: a diagnostic tool for predicting treatment success with mandibular advancement splints in obstructive sleep apnoea. Eur J Orthod 27(6):607–614PubMedCrossRefGoogle Scholar
  17. 17.
    Vanderveken O, Vroegop A, Dieltjens M, Wouters K, Saldien V, Boudewyns A, Verbraecken J, Braem M, Van de Heyning P (2011) 20th Anniversary Meeting of the American Academy of Dental Sleep Medicine, Minneapolis, MN, USA, 10–12 June 2011. Abstract P14 Drug-induced sleependoscopy with simulation bite approach to predict treatment success of oral appliance therapy in adults with sleep-disordered breathing. Sleep Breath 15:260Google Scholar
  18. 18.
    Vanderveken O, Vroegop A, Van de Heyning P, Braem M (2011) Drug-induced sleep endoscopy completed with a simulation bite approach for the prediction of the outcome of treatment of obstructive sleep apnea with mandibular repositioning appliances. Oper Tech Otolaryngol 22(2):175–182CrossRefGoogle Scholar
  19. 19.
    Kezirian E, Goldberg AN (2005) Propofol sleep endoscopy for evaluation in obstructive sleep apnea otolaryngology. Head Neck Surg 133(2):136Google Scholar
  20. 20.
    Rodriguez-Bruno K, Goldberg AN, McCulloch CE, Kezirian EJ (2009) Test–retest reliability of drug-induced sleep endoscopy. Otolaryngol Head Neck Surg 140(5):646–651PubMedCrossRefGoogle Scholar
  21. 21.
    Abdullah B, Rajet KA, Abd Hamid SS, Mohammad WM (2010) A videoendoscopic evaluation of the upper airway in South East Asian adults with obstructive sleep apnea. Sleep Breath 15(4):747–754PubMedCrossRefGoogle Scholar
  22. 22.
    Berry S, Roblin G, Williams A, Watkins A, Whittet HB (2005) Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope 115(3):538–540PubMedCrossRefGoogle Scholar
  23. 23.
    Maurer JT (2006) Current trends in the diagnosis of sleep related breathing disorders. Laryngorhinootologie 85(Suppl 1):11–25PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Corlette Eichler
    • 1
  • J. Ulrich Sommer
    • 1
  • Boris A. Stuck
    • 1
  • Karl Hörmann
    • 1
  • Joachim T. Maurer
    • 1
  1. 1.Sleep Disorders Center, Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Medicine MannheimMannheimGermany

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