Zhao Chen, Viana Alonço, Ma Yifei, Capasso Robson
Department of Otorhinolaryngology, the First Affiliated Hospital of China Medical University, Shenyang, China.
Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, California, USA.
J Thorac Dis. 2020 Jul;12(7):3663-3672. doi: 10.21037/jtd-20-1471.
The Friedman staging is a classic system to predict outcomes of obstructive sleep apnea (OSA) surgery. Increasing stage indicates more severe upper airway (UA) obstruction and worse surgical successful rate. In previous studies, the UA obstruction between stages were usually assessed based on awake examination. Drug-induced sleep endoscopy (DISE) is a new method that can evaluate airway collapse characteristics during sleep. Therefore, we planned to compare Friedman staging and DISE findings and fulfill the knowledge gap on the correlation between awake and sedated UA examination.
Retrospective case series study that assessed patients with OSA who underwent DISE. Subjects were classified to stage II and stage III groups based on Friedman staging system. UA collapse characteristics based on velum, oropharynx, tongue base, epiglottis (VOTE) classification, including single/multiple obstruction sites, single/combined upper and lower obstruction levels, collapse degree and patterns in different sites, and surgical results among the groups were analyzed.
A total of 175 cases were analyzed. No significant differences were found in baseline measurements between groups. Stage III patients (n=102) had a higher proportion (74.5%) with 3 or 4 obstruction sites than stage II (57.5%, n=73). Velum (V) + oropharynx (O) + tongue base (T) was the most common multi-sites combined obstruction pattern with 33% in stage II and 37% in stage III, isolated lower level obstruction was the least with 6% and 4%, respectively. No significant differences were found in obstruction sites and levels. 106 patients underwent surgeries and 33 had post-surgical sleep study, 73.7% and 63.6% response rate were found in stage II and III with no significant difference.
Upper and lower combined obstruction was the main pattern of collapse in both, Friedman stage II and III patients. Patients with OSA and Friedman stage III had more than 2 sites of obstruction than stage II patients.
弗里德曼分期是预测阻塞性睡眠呼吸暂停（OSA）手术结果的经典系统。分期增加表明上气道（UA）阻塞更严重，手术成功率更低。在以往的研究中，各分期之间的UA阻塞通常基于清醒状态下的检查进行评估。药物诱导睡眠内镜检查（DISE）是一种可以评估睡眠期间气道塌陷特征的新方法。因此，我们计划比较弗里德曼分期和DISE检查结果，填补清醒和镇静状态下UA检查相关性方面的知识空白。
一项回顾性病例系列研究，评估接受DISE检查的OSA患者。根据弗里德曼分期系统将受试者分为II期和III期组。分析基于软腭、口咽、舌根、会厌（VOTE）分类的UA塌陷特征，包括单一/多个阻塞部位、单一/上下联合阻塞水平、不同部位的塌陷程度和模式，以及各组之间的手术结果。
共分析了175例病例。两组之间的基线测量无显著差异。III期患者（n = 102）有3个或4个阻塞部位的比例（74.5%）高于II期（57.5%，n = 73）。软腭（V）+口咽（O）+舌根（T）是最常见的多部位联合阻塞模式，II期为33%，III期为37%，孤立的较低水平阻塞最少，分别为6%和4%。阻塞部位和水平无显著差异。106例患者接受了手术，33例进行了术后睡眠研究，II期和III期的有效率分别为73.7%和63.6%，无显著差异。
上下联合阻塞是弗里德曼II期和III期患者塌陷的主要模式。OSA且弗里德曼III期的患者比II期患者有超过2个阻塞部位。
