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

• Published in: Sleep & breathing 2013-03, Vol.17 (1), p.63-68
• Main Authors: Eichler, Corlette, Sommer, J. Ulrich, Stuck, Boris A., Hörmann, Karl, Maurer, Joachim T.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthetics, Intravenous; Biological and medical sciences; Dentistry; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Drug therapy; Endoscopy; Epiglottis - surgery; Female; Fundamental and applied biological sciences. Psychology; Humans; Internal Medicine; Male; Mandibular Advancement; Medical sciences; Medicine; Medicine & Public Health; Midazolam; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Nervous system (semeiology, syndromes); Neurology; Occlusal Splints; Original Article; Otorhinolaryngology; Palate, Soft - surgery; Pediatrics; Pneumology/Respiratory System; Polysomnography; Prognosis; Sleep - drug effects; Sleep apnea; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - surgery; Sleep. Vigilance; Snoring - diagnosis; Snoring - therapy; Tongue - surgery; Tonsillectomy; Vertebrates: nervous system and sense organs
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-012-0647-9

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.