Drug-Induced Sleep Endoscopy vs Awake Muller's Maneuver in the Diagnosis of Severe Upper Airway Obstruction

被引:80
作者
Soares, Danny [1 ,2 ]
Folbe, Adam J. [1 ,2 ]
Yoo, George [1 ,2 ]
Badr, M. Safwan [3 ,4 ]
Rowley, James A. [4 ]
Lin, Ho-Sheng [1 ,2 ,5 ]
机构
[1] Wayne State Univ, Dept Otolaryngol Head & Neck Surg, Detroit, MI 48201 USA
[2] Karmanos Canc Inst, Detroit, MI USA
[3] John D Dingell VA Med Ctr, Dept Med, Detroit, MI USA
[4] Wayne State Univ, Dept Med, Div Pulm Crit Care & Sleep Med, Detroit, MI 48201 USA
[5] John D Dingell VA Med Ctr, Dept Surg, Detroit, MI USA
关键词
sleep endoscopy; Muller's maneuver; retrolingual collapse; obstructive sleep apnea; APNEA SYNDROME; SNORING PATIENTS; MUSCLE-ACTIVITY; UVULOPALATOPHARYNGOPLASTY; EFFICACY; NASOPHARYNGOSCOPY; LOCALIZATION; NASENDOSCOPY; RELIABILITY; SURGERY;
D O I
10.1177/0194599812460505
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Objective. To compare fiber-optic nasal endoscopy with Muller's maneuver (FNMM) against drug-induced sleep endoscopy (DISE) in diagnosing the presence of severe level-specific upper airway collapse in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Study Design. Case series with chart review. Setting. Tertiary care academic center. Subjects and Methods. Medical records of all adult patients undergoing diagnostic DISE as part of their surgical evaluation were reviewed. Patients were included if they had undergone FNMM and had documented Friedman tongue position and tonsillar grade prior to DISE. Airway obstruction on both endoscopic procedures was described according to airway level and severity. Severe airway obstruction was defined as >75% collapse on endoscopy. Results. Fifty-three patients were included in this study. Fiber-optic nasal endoscopy with Muller's maneuver and DISE did not differ significantly regarding the presence of severe retropalatal airway collapse. There was a statistically significant difference in the incidence of severe retrolingual collapse identified via DISE (84.9% [45/53]) compared with FNMM (35.8% [19/53]; P < .0001). This discrepancy between FNMM and DISE findings was statistically significant in individuals with Friedman I and II tongue positions (FNMM = 16.7%, DISE = 88.9%, P < .0001) and individuals with Friedman III tongue position (FNMM = 31.8%, DISE = 81.8%, P = .002). Patients with Friedman IV showed no significant difference (P = .65) between FNMM (69.2%) and DISE (84.6%). Conclusion. This study shows a significant difference between FNMM and DISE in the identification of severe retrolingual collapse. Since the effectiveness of surgical interventions depends largely on the accurate preoperative identification of the site of obstruction, further scrutiny of each diagnostic endoscopic technique is warranted.
引用
收藏
页码:151 / 156
页数:6
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