The contribution of sleep endoscopy in the surgical treatment of obstructive sleep apnea syndrome

Česká verzia

Authors: R. Holouš ¹; J. Betka ²
Authors place of work: Otorinolaryngologické oddělení, Oblastní nemocnice Jičín, a. s. ¹; Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK v Motole, Praha ²
Published in the journal: Otorinolaryngol Foniatr, 69, 2020, No. 4, pp. 158-164.
Category: Original Article

Summary

Objective: The aim of the study was to evaluate the effect of drug-induced sleep endoscopy (DISE) on the change in the indication of surgical therapy in patients with obstructive sleep apnea syndrome (OSAS), which was done by comparing the indication awake. The second part of the research was devoted to evaluating the success of OSAS treatment, especially by comparing the effectiveness of surgery with and without the use of preoperative DISE.

Methods and materials: A prospective study was conducted at the ENT department of the Regional Hospital Jičín Plc. and included a total of 19 patients. The diagnostic-therapeutic process included preoperative limited polygraphy, subjective and objective ENT examination. In 12 patients, preoperative DISE was part of the examination procedure. Follow-up sleep monitoring followed the surgery.

Results: The evaluation of the results revealed that in 5 (42%) patients the indication of the extent of the planned surgery was changed based on the DISE performed. The change has always involved intervention at the level of tongue root. The average efficiency of the surgery according to the reduction of AHI (apnea / hypopnea index) was 59%. The highest average efficacy by AHI reduction was observed in the combination of UPPP (uvulopalatopharyngoplasty) and RFITT (radiofrequency thermotherapy) of the tongue root, namely 62%. In our study, 12 patients using DISE achieved an average AHI reduction of 67% compared to a 48% reduction in AHI in 7 patients without DISE.

Conclusion: The study demonstrated that DISE refines the localization of upper airway obstruction in OSAS patients. The result is a more targeted indication of the extent of surgery in OSAS. The practical consequence of the preoperative use of DISE is the increased effectiveness of surgical treatment of OSAS in our set of patients.

Keywords:

uvulopalatopharyngoplasty – Sleep apnea – drug-induced sleep endoscopy

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