Sleep endoscopy in obstructive sleep apnea – Plain formality or actual gain in knowledge?

Introduction By inclusion of hypoglossal nerve stimulation (HNS) in therapeutic guidelines, obstructive sleep apnea (OSA) has gained new significance in everyday clinical practice in head and neck surger. Drug-induced sleep endoscopy (DISE) plays a central role in the evaluation of the laryngopharyngeal collapse patterns. This paper examines the results of DISE in patients with sleep-related breathing disorders.

Case presentation In the observed period Q4 2022 to Q3 2023, 46 DISEs were performed at the UK HH-Eppendorf. The predominantly male (71.7%) patient collective with a mean age of 55.9 years and a mean overweight BMI of 29.3 kg/m2 showed a mean AHI of 38.4, corresponding to severe OSA. All procedures were performed in TCI-Propofol sedation under BIS control. Velopharyngeal collapse patterns were predominantly mixed (52.2%) and anterior-posterior (a.-p.) (43.5%). Oropharyngeal collapse patterns were exclusively lateral (91.3%), the base of the tongue and the epiglottis collapsed predominantly a.-p. (91.3% and 78.3%, respectively). In cases meeting indication criteria for HNS (n=33), only 2 cases (6.1%) showed a complete-concentric velopharyngeal collapse. Both patients denied bilateral, breath-independent HNS.

Discussion In clinical context of HNS, DISE presents an economic and organizational hurdle due to uneconomical reimbursement. This analysis supports a simultaneous approach of DISE and HNS implantation in the same procedure with a potential failure rate of 6.1%. A predictive clinical test for preoperative assessment of the velopharyngeal collapse pattern would be desirable.

 

MissingLinkText

Publikationsverlauf

Artikel online veröffentlicht:
19. April 2024