Freiser Monika E, Schell Amy E, Soose Ryan J
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
J Clin Sleep Med. 2020 Apr 15;16(4):631-633. doi: 10.5664/jcsm.8240.
Despite excellent positive airway pressure (PAP) adherence, a subset of patients with obstructive sleep apnea experience residual elevation of the apnea-hypopnea index (AHI). Drug-induced sleep endoscopy during PAP application provides an opportunity to examine the anatomic effect of PAP therapy on the upper airway and to troubleshoot refractory residual AHI elevation. We present a patient who demonstrated persistent moderate-severe AHI elevation during titration polysomnogram and subsequent data download reports despite numerous mask refits, chin strap, positional modifications, and multiple pressure and mode adjustments in both the clinic and sleep laboratory settings. Drug-induced sleep endoscopy was performed with the flexible endoscope passed through the PAP circuit into the upper airway. Jaw laxity and associated mandibular retrusion at sleep onset was found to result in a complete fixed tongue base obstruction that PAP therapy, delivered via the patient's oronasal interface, was unable to overcome. Various strategies to overcome these obstacles are discussed.
尽管患者对气道正压通气（PAP）的依从性良好，但仍有一部分阻塞性睡眠呼吸暂停患者的呼吸暂停低通气指数（AHI）残留升高。在应用PAP期间进行药物诱导睡眠内镜检查，为检查PAP治疗对上气道的解剖学影响以及解决难治性AHI残留升高问题提供了机会。我们介绍一位患者，尽管在门诊和睡眠实验室环境中进行了多次面罩调整、使用下颌带、改变体位以及多次调整压力和模式，但在滴定多导睡眠图及随后的数据下载报告中，其AHI仍持续中度至重度升高。通过将柔性内镜经PAP回路插入上气道进行了药物诱导睡眠内镜检查。发现睡眠开始时下颌松弛及相关下颌后缩导致完全性固定舌根阻塞，通过患者口鼻界面进行的PAP治疗无法克服这一阻塞。文中讨论了克服这些障碍的各种策略。
