Beelen A M E H, Vonk P E, de Vries N
Department of Otorhinolaryngology Head and Neck Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
Sleep Breath. 2018 Dec;22(4):909-917. doi: 10.1007/s11325-018-1732-5. Epub 2018 Oct 18.
To evaluate the effect of different passive maneuvers (lateral head rotation and jaw thrust) during drug-induced sleep endoscopy (DISE) on distribution of collapse patterns at the level of velum, oropharynx, tongue base, and epiglottis (VOTE).
Retrospective, single-center cohort study. Patients diagnosed with OSA who underwent DISE between August 2016 and February 2017 were included. During DISE procedure lateral head rotation, jaw thrust and a combination of both were applied and scored by VOTE obstruction level. Also, the effect of these maneuvers was analyzed for complete concentric collapse (CCC) versus complete non-concentric collapse (CNCC) subgroups.
Two hundred patients were included (161 male (80.5%), mean age 50.1 ± 11.7 years, median AHI 19.2 (11.7, 31.0) events/h). For lateral head rotation, significant improvement in upper airway collapse at all levels was observed, with exception of the level of the oropharynx, where an increase in obstruction was seen. Jaw thrust resulted in a significant decrease of collapse on all four VOTE levels. The CCC group responded similarly to the CNCC group when only one maneuver was applied, but the CCC group showed less improvement when both maneuvers were combined.
This study gives new insights into the changes in distribution of collapse patterns when passive maneuvers are applied during DISE. Jaw thrust and lateral head rotation gave improvement of obstruction mostly in line with previous research. The CNCC and CCC groups responded similarly to application of a single maneuver, but there was a significant difference found when both maneuvers were combined.
评估药物诱导睡眠内镜检查（DISE）期间不同被动操作（头部侧转和下颌前推）对软腭、口咽、舌根和会厌（VOTE）水平塌陷模式分布的影响。
回顾性单中心队列研究。纳入2016年8月至2017年2月期间接受DISE的阻塞性睡眠呼吸暂停患者。在DISE过程中，应用头部侧转、下颌前推及其联合操作，并根据VOTE阻塞水平进行评分。此外，还分析了这些操作对完全同心塌陷（CCC）与完全非同心塌陷（CNCC）亚组的影响。
共纳入200例患者（161例男性（80.5%），平均年龄50.1±11.7岁，中位呼吸暂停低通气指数（AHI）为19.2（11.7，31.0）次/小时）。对于头部侧转，除口咽水平阻塞增加外，其他各水平上气道塌陷均有显著改善。下颌前推使所有四个VOTE水平的塌陷显著减少。仅应用一种操作时，CCC组与CNCC组反应相似，但两种操作联合应用时，CCC组改善较小。
本研究为DISE期间应用被动操作时塌陷模式分布的变化提供了新见解。下颌前推和头部侧转对阻塞的改善大多与先前研究一致。CNCC组和CCC组对单一操作的应用反应相似，但两种操作联合应用时存在显著差异。
