Korean J Otorhinolaryngol-Head Neck Surg.  2014 Feb;57(2):96-102. 10.3342/kjorl-hns.2014.57.2.96.

Drug Induced Sleep Endoscopy for Poor-Responder to Uvulopalatopharyngoplasty in Patient with Obstructive Sleep Apnea Patients

• Kim DK
• Lee JW
• Lee JH
• Lee JS
• Na YS
• Kim MJ
• Lee MJ
• Park CH

• KMID: 1508310
• DOI: http://doi.org/10.3342/kjorl-hns.2014.57.2.96

Abstract

BACKGROUND AND OBJECTIVES
The purpose of this study is to evaluate drug-induced sleep endoscopy (DISE) findings in patients with persistent obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP) surgery.
SUBJECTS AND METHOD
Patients were included in this study if they had a postoperative DISE evaluation as well as pre- and postoperative polysomnography. DISE findings included the obstructive sites (velum, oropharyngeal lateral walls, tongue base, and epiglottis), and the obstructive patterns of velopharynx (anteroposterior, lateral, and concentric).
RESULTS
A total of 77 patients were included in this study. Poor-responder patients to UPPP (n=50) and well-responder patients to UPPP (n=27) were similar with regard to age, gender, body mass index, preoperative AHI, and minimal O2 saturation. In our analysis of DISE findings on poor-responder, velopharynx was the most common obstruction site (100%), followed by oropharynx (88%), tongue base (70%), and epiglottis (44%). Results showed that most patients (n=49) had multiple obstructive sites. No significant differences according to position dependency and REM dependency were found in obstructive sites. However, severe OSA patients had tongue base obstruction more frequently than the moderate OSA patients did. The obstructive pattern of velopharynx usually showed concentric configuration (70%, 35 of 50).
CONCLUSION
Our results suggest that the preoperative DISE may be a useful method for determination of the personalized surgery to OSA patients because of its more precise information to upper airway obstruction.

Keyword

Drug-induced sleep endoscopy; Obstructive sleep apnea; Poor-responder; Surgery; Uvulopalatopharyngoplasty

MeSH Terms

Airway Obstruction
Body Mass Index
Endoscopy*
Epiglottis
Humans
Oropharynx
Polysomnography
Sleep Apnea, Obstructive*
Tongue