Abstract
The objectives of our study were to demonstrate the patterns and sites of the upper airway (UA) collapse in obstructive sleep apnea/hypopnea syndrome (OSAHS) patients, utilizing the sleep endoscopy technique, and to describe the technique and summarize our experience in a large series of patients. UA findings during sleep endoscopy with midazolam were examined prospectively in 55 surgical candidates with OSAHS. The uvulopalantine was the most common site of obstruction (89%), followed by the tongue base, hypopharynx and larynx (33% each), and nose (21%); 72% of the patients had multiple obstructions. There was a significant correlation between the number of obstructions and the respiratory distress index (RDI). Laryngeal obstruction was typically supraglottic. Hypopharyngeal obstruction involved concentric UA narrowing. Our findings emphasize the considerable rate of laryngeal and hypopharyngeal obstructions in patients with OSAHS and suggest that their misdiagnosis may explain at least part of the high surgical failure rate of UPPP for OSAHS patients. The number of obstruction sites correlates with respiratory distress index. Sleep endoscopy is safe and simple to perform.
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Lugaresi E, Cirignotta F, Coccagna G et al (1980) Some epidemiological data on snoring and cardiocirculatory disturbances. Sleep 3:221–224
Quinn SJ, Daly N, Ellis PD (1995) Observation of the mechanism of snoring using sleep nasendoscopy. Clin Otolaryngol Allied Sci 20:360–364
Guilleminault C, Stoohs R, Clerk A et al (1993) A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest 104(3):781–787
Guilleminault C, Dement WC (1996) Sleep apnea syndromes and related sleep disorders. In: Williams RL, Karacan I (eds) Sleep disorders: diagnosis and treatment. Wiley, New York, pp 152–155
He J et al (1988) Mortality and apnea index in obstructive sleep apnea. Chest 94:9–14
Nieto FJ, Young TB, Lind BK et al (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep heart health study. JAMA 283:1880–1881
Pringle MB, Croft CB (1991) A comparison of sleep nasendoscopy and the Muller manoeuvre. Clin Otolaryngol Allied Sci 16:559–562
Stein MG, Gansu G, de Geer G et al (1987) Cine CT in obstructive sleep apnea. AJR Am J Roentgenol 148:1069–1074
Rojewski TE, Schuller DE, Clark RW et al (1982) Synchronous video recording of the pharyngeal airway and polysomnography in patients with obstructive sleep apnea. Laryngoscope 92:246–250
Croft CB, Pringle M (1991) Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 16:504–509
Quinn SJ, Daly N, Ellis PD (1995) Observation of the mechanism of snoring using sleep nasendoscopy. Clin Otolaryngol Allied Sci 20:360–364
Camilleri AE, Ramamurthy L, Jones PH (1995) Sleep nasendoscopy: what benefit to the management of snorers? J Laryngol Otol 109(12):1163–1165
Berry S, Roblin G, Williams A et al (2005) Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope 115:538–540
Troell RJ, Riley RW, Powell NB et al (1998) Surgical management of the hypopharyngeal airway in sleep disordered breathing. Otolaryngol Clin North Am 31:979–1012
Li W, Ni D, Jiang H et al (2003) Predictive value of sleep nasendoscopy and the Muller maneuver in uvulopalatopharyngoplasty for the obstructive sleep apnea syndrome (in Chinese). Lin Chuang Er Bi Yan Hou Ke Za Zhi 17:145–146
Steinhart H, Kuhn-Lohmann J, Gewalt K et al (2000) Upper airway collapsibility in habitual snorers and sleep apneics: evaluation with drug-induced sleep endoscopy. Acta Otolaryngol 120:990–994
Abdullah VJ, Wing YK, van Hasselt CA (2003) Video sleep nasendoscopy: the Hong Kong experience. Otolaryngol Clin North Am 36:461–471, vi
Young T, Finn L, Kim H (1997) Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy Clin Immunol 99:S757–S762
Sadaoka T, Kakitsuba N, Fujiwara Y et al (1996) The value of sleep nasendoscopy in the evaluation of patients with suspected sleep-related breathing disorders. Clin Otolaryngol Allied Sci 21:485–489
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Drs. Bachar, Feinmesser and Eidelman contributed equally to this study
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Bachar, G., Feinmesser, R., Shpitzer, T. et al. Laryngeal and hypopharyngeal obstruction in sleep disordered breathing patients, evaluated by sleep endoscopy. Eur Arch Otorhinolaryngol 265, 1397–1402 (2008). https://doi.org/10.1007/s00405-008-0637-5
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DOI: https://doi.org/10.1007/s00405-008-0637-5