Skip to main content
SpringerLink
Log in

Can be compared obstructive respiratory events during drug induced sleep endoscopy (DISE) and nocturnal polysomnography

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Obstructive sleep apnea (OSA) is a collapse of pharynx muscles during sleep that can cause obstruction in the upper airway. It is better to determine the site and pattern of obstruction in the upper airway with drug-induced sleep endoscopy (DISE) before surgery. OSA usually occurs in a non-rapid eye movement (NREM) sleep and sometimes it gets longer and more intense in REM; hence, the study is meant to explore whether the sleep stage and results in DISE may have any similarity with usual nocturnal polysomnography or not.

Materials and methods

In this study, 38 patients with OSA diagnosed on the basis of polysomnography, underwent DISE. Moreover, EEG (12 channels), pulse oximetry and effort channel (respiratory inductance plethysmography) were recorded during DISE to determine the sleep stage and mean respiratory event duration (MRED).

Results

Thirty-eight patients were enrolled in this study. Eighty-four percent (84%) of obstructive respiratory events were observed in NREM sleep in Lab-PSG and 71% in DISE. 28.9% of patients’ events occurred in the wake state in DISE. The mean respiratory event duration (MRED) values in DISE and nighttime sleep were 24.5 ± 7.5 s and 25.4 ± 7.7 s, respectively without significant difference (P value = 0.744), while the minimum values for SPO2 were 74.0 ± 17.3 and 73.6 ± 20.3, respectively (P = 0.885).

Conclusions

Considering the fact that the majority of respiratory events occurred in NREM sleep stage in both PSG and DISE, DISE results can be trusted. Due to absence of REM stage in DISE, the level of the obstruction may mislead the surgeon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235

    Article  CAS  Google Scholar 

  2. Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I et al (2012) Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Intern Med 156(2):115–122

    Article  Google Scholar 

  3. Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M (2008) Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J 15(7):365–369

    Article  Google Scholar 

  4. Turnbull CD, Bratton DJ, Craig SE et al (2016) In patients with minimally symptomatic OSA can baseline characteristics and early patterns of CPAP usage predict those who are likely to be longer-term users of CPAP. J Thorac Dis 8:276–281

    PubMed  PubMed Central  Google Scholar 

  5. Donovan LM, Boeder S, Malhotra A et al (2015) New developments in the use of positive airway pressure for obstructive sleep apnea. J Thorac Dis 7:1323–1342

    PubMed  PubMed Central  Google Scholar 

  6. Virk JS, Kotecha B (2016) Otorhinolaryngological aspects of sleep-related breathing disorders. J Thorac Dis 8:213–223

    Article  Google Scholar 

  7. Rabelo FAW, Küpper DS, Sander HH et al (2013) A comparison of the Fujita classification of awake and drug-induced sleep endoscopy patients. Braz J Otorhinolaryngol 79:100–105

    Article  Google Scholar 

  8. Koo SK, Choi JW, Myung NS, Lee HJ, Kim YJ, Kim YJ (2013) Analysis of obstruction site in obstructive sleep apnea syndrome patients by drug induced sleep endoscopy. Am J Otolaryngol Head Neck Med Surg 34:626–630

    Google Scholar 

  9. Kohn JL, Gillespie MB (2015) Drug-induced sleep endoscopy. Oper Tech Otolaryngol Head Neck Surg 26(2):66–73

    Article  Google Scholar 

  10. Soares D, Folbe AJ, Yoo G et al (2003) Drug-induced sleep endoscopy vs awake Müller’s maneuver in the diagnosis of severe upper airway obstruction. Otolaryngol Head Neck Surg 148:151–156

    Article  Google Scholar 

  11. George JR, Chung S, Nielsen I et al (2012) Comparison of drug induced sleep endoscopy and lateral cephalometry in obstructive sleep apnea. Laryngoscope 122:2600–2605

    Article  Google Scholar 

  12. Kotecha B, De Vito A (2018) Drug induced sleep endoscopy: its role in evaluation of the upper airway obstruction and patient selection for surgical and nonsurgical treatment. J Thorac Dis 10(1):40–47

    Article  Google Scholar 

  13. Capasso R, Rosa T, Yung-An Tsou D et al (2016) Variable findings for drug-induced sleep endoscopy in obstructive sleep apnea with propofol versus dexmedetomidine. Otolaryngol-Head Neck Surg 154(4):765–770

    Article  Google Scholar 

  14. Johal A, Sheriteh Z, Battagel J et al (2011) The use of video fluoroscopy in the assessment of the pharyngeal airway in obstructive sleep apnoea. Eur J Orthod 33:212–219

    Article  Google Scholar 

  15. Carrasco Llatas M, Galofre JD, Martínez RL et al (2005) Our findings in the sleep endoscopy exams. Acta Otorrinolaringol Esp 56(1):17–21

    Article  CAS  Google Scholar 

  16. Abdullah VJ, Wing YK, van Hasselt CA (2003) Video sleep nasendoscopy: the Hong Kong experience. Otolaryngol Clin North Am 36:461–471

    Article  CAS  Google Scholar 

  17. Heo SJ, Park CM, Kim JS (2014) Time-dependent changes in the obstruction pattern during drug-induced sleep endoscopy. Am J Otolaryngol 35(1):42–47

    Article  Google Scholar 

  18. Koo BB, Mansour A (2014) Correlates of obstructive apnea duration. Lung 192(1):185–190. https://doi.org/10.1007/s00408-013-9510-4

    Article  PubMed  Google Scholar 

  19. Mediano O, Barceló A, de la Peña M, Gozal D, Agustí A, Barbé F (2007) Daytime sleepiness and polysomnographic variables in sleep apnoea patients. Eur Respir J 30(1):110–113

    Article  CAS  Google Scholar 

  20. Zhan X, Fang F, Wu C, Pinto JM, Wei Y (2018) A retrospective study to compare the use of the mean apnea–hypopnea duration and the apnea-hypopnea index with blood oxygenation and sleep patterns in patients with obstructive sleep apnea diagnosed by polysomnography. Med Sci Monit 24:1887–1893

    Article  CAS  Google Scholar 

  21. Keong NA, Guan C (2012) Impact of obstructive sleep apnea on sleep-wake stage ratio. 34th annual international conference of the IEEE EMBS San Diego, California USA, 28 August-1 September

  22. San-juan D, Chiappa KH, Cole AJ (2010) Propofol and the electroencephalogram. Clin Neurophysiol 121:998–1006

    Article  CAS  Google Scholar 

  23. Rabelo F, Kupper D, Sander H, Fernandes R, Valera F (2013) Polysomnographic evaluation of propofol-induced sleep in patients with respiratory sleep disorders and controls. Laryngoscope 123(9):2300–2305

    Article  CAS  Google Scholar 

  24. Kushida CA, Chediak A, Berry RB et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4(2):157–171

    Article  Google Scholar 

  25. Owens RL, Eckert DJ, Yeh SY, Malhotra A (2008) Upper airway function in the pathogenesis of obstructive sleep apnea: a review of the current literature. Curr Opin Pulm Med 14:519–524

    Article  Google Scholar 

  26. Kushida CA, Nichols DA, Holmes TH et al (2012) Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the apnea positive pressure long-term efficacy study (APPLES). Sleep 35(12):1593–1602

    Article  Google Scholar 

  27. Engleman HM, Wild MR (2003) Improving CPAP use by patients with the sleep apnoea/hypoponea syndrome (SAHS). Sleep Med Rev 7:81–99

    Article  Google Scholar 

  28. Kezirian EJ (2006) Drug-induced sleep endoscopy. Oper Tech Otolaryngol 17(4):230–232

    Article  Google Scholar 

  29. Wirth M, Schramm J, Bautz M, Hofauer B, Edenharter G, Ott A, Heiser C (2018) Reduced upper obstructions in N3 and increased lower obstructions in REM sleep stage detected with manometry. Eur Arch Oto-Rhino-Laryngol 275(1):239–245

    Article  Google Scholar 

  30. Abdullah VJ, Lee DLY, Nam Ha SC et al (2012) Sleep endoscopy with midazolam: sedation level evaluation with bispectral analysis. Otolaryngol Head Neck Surg 148(2):185–190

    Google Scholar 

  31. Mokhlesi B, Punjabi NM (2012) "REM-related" obstructive sleep apnea: an epiphenomenon or a clinically important entity? Sleep 35(1):5–7

    Article  Google Scholar 

  32. Conwell W, Patel B, Doeing D et al (2012) Prevalence, clinical features, and CPAP adherence in REM- related sleep-disordered breathing: a cross sectional analysis of a large clinical population. Sleep Breath 16:519–526

    Article  Google Scholar 

  33. Wirth M, Schramm J, Bautz M, Hofauer B, Edenharter G, Ott A, Heiser C (2018) Reduced upper obstructions in N3 and increased lower obstructions in REM sleep stage detected with manometry. Eur Arch Oto-Rhino-Laryngolog 275(1):239–245

    Article  Google Scholar 

  34. Hao W, Xiaojun Z, Mengneng Z, Yongxiang W (2016) Mean apnea–hypopnea duration (but not apnea–hypopnea index) is associated with worse hypertension in patients with obstructive sleep apnea. Medicine 9548:e5493

    Google Scholar 

  35. Da Cunha Viana AJ, Mendes DL, De Andrade Lemes LN, Thuler LC, Neves DD, de Araújo-Melo MH (2017) Drug-induced sleep endoscopy in the obstructive sleep apnea: comparison between NOHL and VOTE classifications. Eur Arch Otorhinolaryngol 274(2):623–627

    Google Scholar 

Download references

Funding

This study received no funding.

Author information

Authors and Affiliations

  1. Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Jahangir Ghorbani, Ali Safavi Naeini & Kosar Sadeghi Haghighi

  2. Clinical Tuberculosis and Epidemiologic Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Parisa Adimi Naghan

Authors
  1. Jahangir Ghorbani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Parisa Adimi Naghan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali Safavi Naeini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kosar Sadeghi Haghighi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Authors JG, PAN, ASN, and KSH conceived and planned the experiments, authors PAN and KSH carried out the experiments. Author JG contributed to sample preparation. Authors JG, PAN, and KSH contributed to the interpretation of the results. Author KSH took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research, analysis, and manuscript.

Corresponding author

Correspondence to Kosar Sadeghi Haghighi.

Ethics declarations

Conflicts of interest

The authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee [Ethic Committee of Shahid Beheshti University of Medical Science (NO: IR.SBMU.NRITLD.REC.1397.505)] and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghorbani, J., Adimi Naghan, P., Safavi Naeini, A. et al. Can be compared obstructive respiratory events during drug induced sleep endoscopy (DISE) and nocturnal polysomnography. Eur Arch Otorhinolaryngol 277, 1379–1384 (2020). https://doi.org/10.1007/s00405-020-05848-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-05848-5

Keywords

Search

Navigation