Faculty of Medicine, Department of Anesthesiology and Reanimation, Subdivision of Critical Care Medicine, Dokuz Eylül University, Izmir, Turkey.
Faculty of Medicine, Department of Otorihinolaryngology, Dokuz Eylül University, Izmir, Turkey.
Medicine (Baltimore). 2023 Sep 22;102(38):e35209. doi: 10.1097/MD.0000000000035209.
The aim of this study was to investigate both the presence and severity of collapse in anatomical regions defined by the VOTE score (velum, orofarinx, tongue, and epiglottis), during drug induced sleep endoscopy (DISE) in patients diagnosed with obstructive sleep apnea, based on the bi-spectral index (BIS) sedation level.
In order to conduct a meta-analysis of articles examining the relationship between the VOTE score and BIS sedation level in determining the presence and severity of upper airway collapse during DISE, a literature review was performed.
As a result of the search made in the specified databases, a total of 1864 articles were reached. Five articles included in this review that had sufficient statistical data to be included in the meta-analysis were found. A statistically significant correlation was found between the BIS sedation level and the areas of obstruction in the VOTE score. The strongest association is at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively (CC: 0.639, CC: 0.53, CC: 0.49, and CC: 0.346, P < .001). In the subgroup analysis of publications with BIS sedation levels in the range of 60 to 65, the distribution in the epiglottis region was heterogeneous, and it was found to be statistically significant according to the random effect model (P < .001). The distribution in the tongue was homogeneous, and it was found to be statistically significant according to the fixed effect model (P < .001). When the publications in which the BIS sedation level is in the range of 65 to 75 are examined according to the areas of obstruction; the distribution in 4 anatomical regions was homogeneous and statistically significant according to the fixed effect model (P < .001).
It was found that BIS sedation levels during DISE application in obstructive sleep apnea patients were associated with obstruction of the anatomical regions of the upper airway. The strongest association was found at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively. It is helpful to monitor the sedation level with BIS in order to better define the collapsed areas during DISE application. However, more studies are needed to better understand the relationship between BIS sedation values and sleep stages.
本研究旨在探讨基于双谱指数（BIS）镇静水平，在诊断为阻塞性睡眠呼吸暂停的患者中，药物诱导睡眠内镜检查（DISE）期间，根据 VOTE 评分（软腭、口咽、舌和会厌）确定的解剖区域内的塌陷存在和严重程度。
为了对研究 VOTE 评分与 BIS 镇静水平在确定 DISE 期间上气道塌陷存在和严重程度的关系的文章进行荟萃分析，进行了文献回顾。
在所指定的数据库中进行搜索后，共获得了 1864 篇文章。发现了 5 篇包含足够统计数据以纳入荟萃分析的综述文章。发现 BIS 镇静水平与 VOTE 评分中的阻塞区域之间存在统计学显著相关性。最强的关联分别是会厌水平、软腭、口咽和舌（CC：0.639、CC：0.53、CC：0.49 和 CC：0.346，P<.001）。在 BIS 镇静水平在 60 到 65 范围内的出版物的亚组分析中，会厌区域的分布不均匀，根据随机效应模型发现具有统计学意义（P<.001）。舌的分布均匀，根据固定效应模型发现具有统计学意义（P<.001）。根据阻塞区域检查 BIS 镇静水平在 65 到 75 范围内的出版物时，4 个解剖区域的分布根据固定效应模型均匀且具有统计学意义（P<.001）。
发现阻塞性睡眠呼吸暂停患者在 DISE 应用期间的 BIS 镇静水平与上气道解剖区域的阻塞有关。最强的关联分别是会厌水平、软腭、口咽和舌。使用 BIS 监测镇静水平有助于更好地定义 DISE 应用期间的塌陷区域。然而，需要更多的研究来更好地理解 BIS 镇静值与睡眠阶段之间的关系。
