Ong Adrian A, Murphey Alexander W, Nguyen Shaun A, Soose Ryan J, Woodson B Tucker, Vanderveken Olivier M, de Vries Nico, Gillespie M Boyd
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Otolaryngol Head Neck Surg. 2016 May;154(5):970-7. doi: 10.1177/0194599816636835. Epub 2016 Mar 15.
To describe upper airway collapse patterns observed on drug-induced sedation endoscopy (DISE) during screening for a clinical trial and to evaluate the impact of collapse patterns found on preoperative DISE on response rates to upper airway stimulation (UAS) therapy.
Retrospective review of an ongoing prospective multi-institutional cohort study.
Twenty-two participating institutions of the STAR trial.
In total, 222 subjects were screened with DISE to determine eligibility for an implantable UAS device. Supine laryngoscopy was performed during moderate sedation (propofol and/or midazolam). Airway collapse pattern and severity were graded at 4 levels, including velum, oropharynx, tongue base, and epiglottis (VOTE classification). Patients with complete concentric collapse (CCC) at the velum were excluded from implantation.
The CCC at the velum was observed in 52 (23%) of screened subjects, and these subjects were subsequently excluded from implantation. Of the 170 subjects without CCC at the velum, 126 (77%) underwent implantation: 121 (96%) had multilevel collapse and 5 (4%) had single-level collapse. When comparing preimplantation DISE findings, UAS responders at 12 months had lower baseline VOTE scores compared with therapy nonresponders.
Drug-induced sedation endoscopy is an efficient and safe method for determining UAS eligibility and has the potential to identify UAS nonresponders. Most patients had multilevel airway collapse, illustrating the limitations of single-level upper airway surgery in treating obstructive sleep apnea. Upper airway stimulation is effective therapy for most patients with multilevel airway collapse; however, patients with complete anterior-posterior or lateral soft palate and/or epiglottic collapse may be at increased risk of therapy failure.
描述在一项临床试验筛查期间药物诱导镇静内镜检查（DISE）所观察到的上气道塌陷模式，并评估术前DISE所发现的塌陷模式对上气道刺激（UAS）治疗反应率的影响。
对一项正在进行的前瞻性多机构队列研究进行回顾性分析。
STAR试验的22个参与机构。
共有222名受试者接受DISE筛查，以确定是否适合植入可植入式UAS设备。在中度镇静（丙泊酚和/或咪达唑仑）期间进行仰卧位喉镜检查。气道塌陷模式和严重程度分为4级，包括软腭、口咽、舌根和会厌（VOTE分类）。软腭出现完全同心塌陷（CCC）的患者被排除在植入范围之外。
在筛查的受试者中，52名（23%）观察到软腭CCC，这些受试者随后被排除在植入范围之外。在170名软腭无CCC的受试者中，126名（77%）接受了植入：121名（96%）有多级塌陷，5名（4%）有单级塌陷。比较植入前DISE结果时，12个月时UAS反应者的基线VOTE评分低于治疗无反应者。
药物诱导镇静内镜检查是确定UAS适用性的一种有效且安全的方法，并且有可能识别UAS无反应者。大多数患者有多级气道塌陷，这说明了单级上气道手术在治疗阻塞性睡眠呼吸暂停方面的局限性。上气道刺激对大多数有多级气道塌陷的患者是有效的治疗方法；然而，软腭和/或会厌出现完全前后或侧向塌陷的患者治疗失败的风险可能会增加。
