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Diagnosis of upper airways collapse in moderate-to-severe OSAHS patients: a comparison between drug-induced sleep endoscopy and the awake examination

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Abstract

Purpose

Compare awake evaluation (modified Mallampati score—MMs, Müller maneuver—MM) to drug-induced sleep endoscopy (DISE) findings according to NOHL (nose–oropharynx–hypopharynx–larynx) classification in moderate-to-severe OSAHS patients.

Methods

43 moderate-to-severe OSAHS patients referred to our ENT department were enrolled over a 2-year period. In this observational prospective study, each patient was evaluated by the same ENT team both in wakefulness and during pharmacologically induced sleep. Level and severity of the obstruction were described.

Results

The comparison of degree of collapsibility was statistically significative only at hypopharyngeal level: 41.8% of the patients showed a hypopharyngeal obstruction in wakefulness whereas 88.3% in DISE (p = 0.000). Laryngeal level was found in 18.6% patients during awake examination, conversely DISE demonstrated laryngeal obstruction in 4.6%. DISE identified significantly higher incidence of multilevel collapses (p = 0.001). However, the incidence of oropharyngeal obstruction in patients classified as MMs I and II was significantly higher in DISE compared to MM (p = 0.021).

Conclusion

DISE is the best predictor of hypopharyngeal obstruction, whereas MM underestimates the severity of the collapse at this level. DISE is more reliable than MM to identify the obstruction in patients with MMs score I and II.

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Availability of data and materials

Data are available upon reasonable request to the corresponding author.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy

    Ilaria Bindi

  2. Otolaryngology Department, University of Perugia, Sant’Andrea delle Fratte, 06129, Perugia, Italy

    Michele Ori, Mauro Marchegiani, Maddalena Morreale, Luigi Gallucci & Giampietro Ricci

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  1. Ilaria Bindi
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  2. Michele Ori
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  3. Mauro Marchegiani
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  4. Maddalena Morreale
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  5. Luigi Gallucci
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Contributions

Conceptualization: [IB, LG]. Methodology: [IB, LG]. Formal analysis and investigation: [IB, MO, MM, MM]. Writing—original draft preparation: [IB]. Writing—review and editing: [IB, MO, LG]. Supervision: [GR, LG].

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Correspondence to Ilaria Bindi.

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Bindi, I., Ori, M., Marchegiani, M. et al. Diagnosis of upper airways collapse in moderate-to-severe OSAHS patients: a comparison between drug-induced sleep endoscopy and the awake examination. Eur Arch Otorhinolaryngol 279, 2167–2173 (2022). https://doi.org/10.1007/s00405-021-07184-8

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