Kuo Yu-Hsuan, Liu Tien-Jen, Chiu Feng-Hsiang, Chang Yi, Lin Chia-Mo, Jacobowitz Ofer, Hsu Ying-Shuo
Department of Otolaryngology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Department of Otolaryngology Head & Neck Surgery, MacKay Memorial Hospital, Taipei Branch, Taipei, Taiwan.
Nat Sci Sleep. 2021 Nov 24;13:2087-2099. doi: 10.2147/NSS.S327770. eCollection 2021.
In intermittent negative airway pressure (iNAP) therapy, soft tissues are reshaped into a forward-resting position, thus reducing airway obstruction during sleep. This study investigated the effect of iNAP therapy that was administered during drug-induced sleep endoscopy with target-controlled infusion (TCI-DISE) in patients with obstructive sleep apnea (OSA) intolerant of continuous positive airway pressure (CPAP) therapy.
This prospective case series study included 92 patients with polysomnography (PSG)-confirmed OSA who underwent TCI-DISE with iNAP from January 2018 to February 2020 at a tertiary referral hospital. Upper airway obstruction was evaluated and scored using the velum, oropharynx, tongue base, and epiglottis (VOTE) classification. Obstruction severity was assessed multiple times with the patient in the supine position with or without lateral rotation of the head and the application of iNAP therapy, respectively.
After the application of iNAP therapy in the supine position, obstruction severity decreased significantly: from complete or partial obstruction to partial or no obstruction in 37, 12, and 36 patients (40.2%, 13%, and 39%, respectively) with velar obstruction, oropharyngeal, and tongue base obstruction, respectively. After simultaneously applying iNAP therapy with head rotation, obstruction severity decreased in 47, 43, and 19 patients (51%, 47%, and 21%, respectively) with velar, tongue base, and epiglottic obstruction, respectively.
In TCI-DISE, we found that iNAP therapy relieved velar, oropharyngeal, and tongue base obstruction in the supine position in some patients. Moreover, iNAP therapy can be combined with positional therapy to alleviate velar, tongue base, and epiglottic obstruction in some patients. TCI-DISE can also be used to screen the possible responders for iNAP therapy because it is less time consuming than PSG.
在间歇性气道负压（iNAP）治疗中，软组织被重塑至向前的静息位置，从而减少睡眠期间的气道阻塞。本研究调查了在药物诱导睡眠内镜检查联合靶控输注（TCI-DISE）期间给予iNAP治疗对不耐受持续气道正压通气（CPAP）治疗的阻塞性睡眠呼吸暂停（OSA）患者的影响。
这项前瞻性病例系列研究纳入了92例经多导睡眠图（PSG）确诊的OSA患者，这些患者于2018年1月至2020年2月在一家三级转诊医院接受了TCI-DISE联合iNAP治疗。使用软腭、口咽、舌根和会厌（VOTE）分类对气道阻塞进行评估和评分。分别在患者仰卧位且头部无侧向旋转以及应用iNAP治疗的情况下多次评估阻塞严重程度。
在仰卧位应用iNAP治疗后，阻塞严重程度显著降低：软腭阻塞、口咽阻塞和舌根阻塞的患者中，分别有37例（40.2%）、12例（13%）和36例（39%）从完全或部分阻塞降至部分或无阻塞。在头部旋转同时应用iNAP治疗后，软腭阻塞、舌根阻塞与会厌阻塞的患者中，分别有47例（51%）、43例（47%）和19例（21%）阻塞严重程度降低。
在TCI-DISE中我们发现，iNAP治疗可缓解部分患者仰卧位时软腭阻塞、口咽阻塞和舌根阻塞。此外，iNAP治疗可与体位治疗联合使用，以缓解部分患者的软腭阻塞、舌根阻塞与会厌阻塞。TCI-DISE还可用于筛查可能对iNAP治疗有反应的患者，因为它比PSG耗时少。
