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    Comparison of Drug-Induced Sleep Endoscopy Ver2

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    The study aimed to compare drug-induced sleep endoscopy (DISE) and Müller’s maneuver (MM) in identifying sites of upper airway collapse in 63 patients with obstructive sleep apnea syndrome. There was significant concordance between DISE and MM in diagnosing velum and oropharynx obstructions, but less agreement on degree of tongue collapse. The study concluded DISE and MM are both valid for identifying severity of upper airway collapse, though MM is cheaper and easier to perform.

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    Comparison of Drug-Induced Sleep Endoscopy Ver2

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    thtkl
    84 views34 pages
    The study aimed to compare drug-induced sleep endoscopy (DISE) and Müller’s maneuver (MM) in identifying sites of upper airway collapse in 63 patients with obstructive sleep apnea syndrome. There was significant concordance between DISE and MM in diagnosing velum and oropharynx obstructions, but less agreement on degree of tongue collapse. The study concluded DISE and MM are both valid for identifying severity of upper airway collapse, though MM is cheaper and easier to perform.

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    The study aimed to compare drug-induced sleep endoscopy (DISE) and Müller’s maneuver (MM) in identifying sites of upper airway collapse in 63 patients with obstructive sleep apnea syndrome. There was significant concordance between DISE and MM in diagnosing velum and oropharynx obstructions, but less agreement on degree of tongue collapse. The study concluded DISE and MM are both valid for identifying severity of upper airway collapse, though MM is cheaper and easier to perform.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    84 views34 pages

    Comparison of Drug-Induced Sleep Endoscopy Ver2

    Uploaded by

    thtkl
    The study aimed to compare drug-induced sleep endoscopy (DISE) and Müller’s maneuver (MM) in identifying sites of upper airway collapse in 63 patients with obstructive sleep apnea syndrome. There was significant concordance between DISE and MM in diagnosing velum and oropharynx obstructions, but less agreement on degree of tongue collapse. The study concluded DISE and MM are both valid for identifying severity of upper airway collapse, though MM is cheaper and easier to perform.

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    Download as pptx, pdf, or txt
    of 34

    Yakup Yegïn, Mustafa C¸elik , Kamïl Hakan Kaya, Arzu Karaman Koc, Fatma Tülin Kayhan

    Presented by :
    dr. Belly Sutopo Wijaya

    Mentors :
    dr. Puspa Zuleika, Sp.T.H.T.K.L.(K), M.Kes., FICS
    dr. Erial Bahar, M.Sc
    INTRODUCTION
    Section Break

    Obstructive sleep apnea Syndrome (OSAS)  syndrome


    characterized by recurrent episodes of sleep apnea and hypopnea
    caused by repetitive upper airway collapse

    Knowledge of the site of obstruction & the pattern of airway


    collapse is essential for determining correct surgical & medical
    management of patients with OSAS
    OBJECTIVE

    To determine whether drug-induced sleep endoscopy (DISE)


    or Müller’s maneuver (MM) would be more successful at identifying
    the site of obstruction and the pattern of upper airway collapse
    in patients with OSAS
    METHODS
    Infographic Style
    TIME METHOD
    November 2013 –
    Crossectional Study
    August 2014

    PLACE
    Department of Otorhinolaryngology – Head and Neck Surgery,
    Bakirkoy Dr. Sadi Konuk Training and Research Hospital,
    Istanbul, Turkey
    INCLUSION CRITERIA EXCLUSION CRITERIA

    • OSAS patient • < 18 y.o


    • AHI > 5 • BMI > 40
    • ASA gr. 3-4
    • Patients who refused
    surgical therapy
    PROCEDURE
    63 OSAS
    patients

    Evaluate : ESS, AHI, BMI, Neck circumference

    MM DISE

    VOTE Classification

    Cohen’s kappa test


    RESULT
    RESULT

    k= 0.414

    (anteroposterior, k= 0.55),lateral, k= 0.348)


    and concentric, k = 0.555)
    RESULT

    k = 0.107
    k = 0.026
    k = 0.383
    DISCUSSION
    Kezirian EJ, Hohenhorst W, de Vries N  Uvula & soft palate are the main fact
    or involved in the collapse of the velopharyngeal level in patient with OSAS

     In this study, there was statistically significant concordance ~ 2 endoscopic

    procedures for all configurations at velopharyngeal-related obstruction

    Koo SK, Choi JW, Myung NS, et al.  Tongue-related obstruction is a common
    finding in OSAS and mainly identified in an antero-posterior configuration.
     In this study, the presence & degree of tongue obstruction differed by method,
    with MM indicating severe collapse in 20 patients and DISE indicating severe
    collapse in 51 patients in the anteroposterior configuration at the tongue level.
    DISCUSSION
    • Gregorio, et al  ↑ retroglossal obstructions detect during DISE compare to MM

     In this study, DISE is not a natural sleeping state. During propofol unconscious
    sedation, reductions in genioglossus tone also occur and can contribute to tongue
    base collapse.

    Lee CH, Kim DK, Kim SY, Rhee CS, Won TB  Tonsils, lateral pharyngeal wall &
    adjacent parapharyngeal fat pads contribute to the collapse of the oropharyngeal
    The obstruction occur via collapse in the lateral & concentric configuration.
     In this study, statistically significant concordance in the diagnosis of
    oropharyngeal-related obstructions in the lateral configuration ~ DISE & MM
    CONCLUSION
    Infographic Style
    Significant concordance
    in the diagnoses of DISE + VOTE Classification
    obstructions related to  valid, safe, easy-to-use
    the velum and for identifying the severity
    oropharynx between of upper airway collapse
    MM and DISE

    MM can be performed in patients with OSAS


    to determine the site of obstruction in the upper
    airways since it is a cheap & easily performed
    method that can provide some knowledge
    of the pattern of pharyngeal collapse
    CRITICAL APPRAISAL
    Is the background of the study clearly stated ?

    YES
    What is the objective of this research ?

    To determine whether drug-induced sleep endoscopy (DISE)


    or Müller’s maneuver (MM) would be more successful at
    identifying the site of obstruction and the pattern of
    upper airway collapse in patients with OSAS
    Was there an independent, blind comparison
    with a reference (“gold”) standard of diagnosis?

    YES
    Was the diagnostic test evaluated in an
    appropriate spectrum of patients (like those in
    whom it would be used in practice)?

    YES
    Was the reference standard applied regardless of
    the diagnostic test result?

    YES
    Was the test (or cluster of tests) validated in a
    second, independent group of patients?

    YES
    Is the diagnostic test available, affordable,
    accurate, and precise in your setting?

    YES
    Is it unlikely that the disease possibilities or
    probabilities have changed since the evidence
    was gathered?

    NO
    Was the validity of the data can be verified?

    YES
    What kind of association analysis was obtained?
    • Significant concordance in the diagnoses of obstructions related to
    the velum & oropharynx between MM & DISE
     There is lack concordance between MM & DISE on degree of
    tongue obstruction, MM indicating severe collapse in 20 patients &
    DISE severe collapse in 51 patients in the anteroposterior
    configuration at the tongue level.
    • DISE + VOTE Classification  valid, safe, easy-to-use for
    identifying the severity of upper airway collapse
    CONCLUSION

    Valid Important Applicable


    THANK YOU
    Apnea–Hypopnea Index (AHI)
    • Indicate the severity of sleep apnea  Represented by number of
    apnea and hypopnea events per hour of sleep.
    • Apnea (pauses in breathing)  last for at least 10s and associated with
    ↓ blood oxygenation.
    AHI  dividing the number of apnea events by the number of hours of sleep.
    • Normal: AHI < 5 events per hour
    • Mild sleep apnea: AHI score 5 -15 per events per hour
    • Moderate sleep apnea: AHI score 15 -30 per events per hour
    • Severe sleep apnea: AHI ≥ 30 events per hour
    Epworth Sleepiness Scale

    • 0–9 range = normal


    • 10–24 range = expert medical advice s
    hould be sought
    • 11-15 = possibility of mild to moderate
    sleep apnea
    • ≥ 16 = severe sleep apnea or narcolep
    sy
    VOTE Classification

    Degree of obstruction:
    (0) no obstruction (no vibration, <50%);
    (1) partial obstruction (vibration 50-75%);
    (2) complete obstruction (collapse, >75%);
    (x) not visualized
    Friedmann Classification
    D.I.S.E. M.M.
    VIDEO VIDEO
    Uvulopalatopharyngoplasty

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