ENT Division, Clinics Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes, 3900-12o andar, CEP 14049-900, Ribeirão Preto, São Paulo, Brazil.
Anesthesiology Division, Clinics Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
Sleep Breath. 2022 Mar;26(1):109-116. doi: 10.1007/s11325-021-02360-w. Epub 2021 Apr 8.
Drug-induced sleep endoscopy (DISE) has been poorly explored as an examination to assess positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA). The present study aimed to identify by DISE possible characteristics related to low compliance with PAP therapy due to respiratory complaints.
Patients using PAP for OSA underwent DISE in two conditions: (1) baseline (without PAP) and (2) PAP (with the same mask and airway pressure used at home). We compared patients reporting low compliance to PAP due to respiratory complaints to those well-adapted to therapy. VOTE classification (assessment of velopharynx, oropharynx, tongue base, and epiglottis) and TOTAL VOTE score (the sum of VOTE scores at each anatomical site) were assessed. ROC curve analyzed the accuracy of TOTAL VOTE to predict low compliance due to persistent pharyngeal obstruction in both conditions.
Of 19 patients enrolled, all presented multilevel pharyngeal obstruction at baseline condition, with no difference between groups at this study point. When PAP was added, the median VOTE value was higher in the epiglottis (P value=0.02) and tended to be higher at the velum and tongue base in the poorly adapted group; TOTAL VOTE score was also significantly increased in patients with low compliance (P value<0.001). ROC curve demonstrated that patients with TOTAL VOTE scored 2.5 or more during DISE with PAP presented a 4.6-fold higher risk for low compliance with PAP therapy due to pharyngeal obstruction (AUC: 0.88±0.07; P value<0.01; sensitivity: 77%; specificity: 83%).
Adding PAP during a DISE examination may help to predict persistent pharyngeal obstruction during PAP therapy.
药物诱导睡眠内镜（DISE）作为一种评估阻塞性睡眠呼吸暂停（OSA）患者气道正压（PAP）治疗的检查方法，尚未得到充分探索。本研究旨在通过 DISE 识别与因呼吸问题而对 PAP 治疗依从性低相关的可能特征。
使用 PAP 治疗 OSA 的患者在两种情况下接受 DISE 检查：（1）基线（无 PAP）和（2）PAP（使用在家中使用的相同面罩和气道压力）。我们将因呼吸问题而对 PAP 治疗依从性低的患者与对治疗适应良好的患者进行比较。评估 VOTE 分类（评估软腭、口咽、舌基和会厌）和 TOTAL VOTE 评分（每个解剖部位的 VOTE 评分总和）。ROC 曲线分析 TOTAL VOTE 在两种情况下预测因持续性咽阻塞导致的低依从性的准确性。
19 名入组患者在基线条件下均存在多水平咽阻塞，两组在这一点上无差异。当添加 PAP 时，会厌的 VOTE 值中位数较高（P 值=0.02），且在适应性差的组中软腭和舌基的 VOTE 值倾向于较高；低依从组的 TOTAL VOTE 评分也显著升高（P 值<0.001）。ROC 曲线表明，在 DISE 期间使用 PAP 时 TOTAL VOTE 评分达到 2.5 或更高的患者，因咽阻塞而对 PAP 治疗的依从性降低的风险增加 4.6 倍（AUC：0.88±0.07；P 值<0.01；敏感性：77%；特异性：83%）。
在 DISE 检查中添加 PAP 可能有助于预测 PAP 治疗期间持续性咽阻塞。
