Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Otolaryngol Head Neck Surg. 2023 Nov;169(5):1345-1355. doi: 10.1002/ohn.364. Epub 2023 May 20.
To identify the value of head rotation in the supine position and oral appliance (OA) use in drug-induced sleep endoscopy (DISE).
Eighty-three sleep apnea adults undergoing target-controlled infusion-DISE (TCI-DISE) were recruited from a tertiary academic medical center.
During DISE, 4 positions were utilized: supine position (position 1), head rotation (position 2), mandibular advancement using an OA (position 3), and head rotation with an OA (position 4).
Polysomnography (PSG) data and anthropometric variables during DISE were analyzed.
Eighty-three patients (65 men and 18 women; mean [standard deviation, SD], 48.5 [11.0] years) who underwent PSG and TCI-DISE were included. The mean (SD) apnea-hypopnea index (AHI) was 35.5 (22.4) events/h. Twenty-three patients had persistent complete concentric velopharyngeal collapse in the supine position, even with concurrent head rotation and OA (position 4). Their mean (SD) AHI was 54.7 (24.6) events/h, significantly higher than that of the 60 patients without such collapse in position 4 (p < .001). Their mean (SD) body mass index (BMI) was 29.0 (4.1) kg/m , also significantly higher (p = .005). After adjustment for age, BMI, tonsil size, and tongue position, the degree of velum and tongue base obstruction was significantly associated with sleep apnea severity in positions 2, 3, and 4.
We showed the feasibility, safety, and usefulness of using simple edge-to-edge, reusable OA in DISE. Patients who are not responsive to head rotation and OA during TCI-DISE may need upper airway surgery and/or weight control.
在药物诱导睡眠内镜检查（DISE）中确定仰卧位头旋转和口腔矫治器（OA）使用的价值。
从一家三级学术医疗中心招募了 83 名接受靶控输注-DISE（TCI-DISE）的睡眠呼吸暂停成年人。
在 DISE 期间，使用了 4 个位置：仰卧位（位置 1）、头旋转（位置 2）、使用 OA 进行下颌前伸（位置 3）和头旋转与 OA（位置 4）。
分析 DISE 期间的多导睡眠图（PSG）数据和人体测量变量。
83 名患者（65 名男性和 18 名女性；平均[标准差，SD]，48.5[11.0]岁）接受了 PSG 和 TCI-DISE。平均（SD）呼吸暂停低通气指数（AHI）为 35.5（22.4）事件/h。23 名患者在仰卧位时持续存在完全同心的软腭后区塌陷，即使同时进行头旋转和 OA（位置 4）也是如此。他们的平均（SD）AHI 为 54.7（24.6）事件/h，明显高于位置 4 中无此类塌陷的 60 名患者（p<0.001）。他们的平均（SD）体重指数（BMI）为 29.0（4.1）kg/m ，也明显更高（p=0.005）。在调整年龄、BMI、扁桃体大小和舌位置后，在位置 2、3 和 4 中，软腭和舌基底阻塞的程度与睡眠呼吸暂停严重程度显著相关。
我们展示了在 DISE 中使用简单的边缘到边缘、可重复使用的 OA 的可行性、安全性和有用性。在 TCI-DISE 期间对头部旋转和 OA 无反应的患者可能需要上气道手术和/或体重控制。
