Evaluation of The Obstruction Localization with Sleep Endoscopy in Obstructive Sleep Apnea Patients

Year 2021, , 5 - 10, 16.12.2021

Mümtaz Taner Torun

https://doi.org/10.29228/HMJ.2

Abstract

Objective The aim is to evaluate awake and sleep endoscopy (SE) findings in patients with obstructive sleep apnea syndrome (OSAS) with NOHL (nose-oropharynx-hypopharynxlarynx)
classification, to reveal the differences between the two methods and to determine whether the severity of OSAS is related to anatomical localization.
Materials and Methods OSAS patients were included in the study. Patients were divided into three groups as mild, moderate and severe OSAS. SE was performed with sedation to all patients.
Endoscopic findings were scored according to the NOHL classification.
Results Seventy patients were included in the study. In the awake endoscopic examination, only one level of obstruction was detected in 6 patients, while two or more levels of
obstruction were detected in 64 patients. When SE findings were evaluated, there was no change in the level of obstruction in 6 patients in the mild group, 6 patients in
the moderate group, and 4 patients in the severe group, while a change in the obstruction level was found in the other patients. These changes were found to be statistically
significant (p<0.001).
Conclusion In recent years, it has been reported that the treatments applied as a result of the evaluation of the level and pattern of obstruction are more successful. While collapse in
the upper respiratory tract is at a single level in a few patients, it is detected at multiple levels in many patients. Collapse and anatomical condition determined by SE are
extremely important in treatment management and are reported to be preferred to standard awake endoscopy.

Keywords

Obstructive sleep apnea, Sleep endoscopy, NOHL classification, Obstruction pattern

Obstrüktif Uyku Apnesi Hastalarında Obstruksiyon Lokalizasyonunun Uyku Endoskopisi ile Değerlendirilmesi

Abstract

Amaç Obstrüktif uyku apnesi sendromu (OUAS) hastalarında uyanık ve uyku endoskopisi bulgularını NOHL (nose-oropharynx-hypopharynx-larynx) klasifikasyonu ile değerlendirmek,
iki yöntem arasındaki farklılıkları ortaya koymak ve OUAS şiddetinin anatomik lokalizasyonla ilişkili olup olmadığını saptamaktır.
Gereç ve Yöntemle Çalışmaya polisomnografi sonucu uyku apnesi saptanan hastalar alındı. Hastalar hafif, orta ve ağır OUAS olarak üç gruba ayrıldı. Hastalara rutin KBB muayenesini takiben
fleksibl fiberoptik nazofarengolaringoskopi uygulandı ve bulgular NOHL klasifikasyonuna göre skorlandırıldı. Tüm hastalara sedasyon uygulanarak uyku endoskopisi
yapıldı.
Bulgular Çalışmaya 70 hasta dahil edildi. Uyanık iken yapılan endoskopik muayenede sadece 6 hastada tek seviye obstrüksiyon saptanırken 64 hastada iki ya da daha fazla seviyede
obstrüksiyon saptandı. Tüm lokalizasyonlar arasında en sık obstrüksiyon palatal bölgede saptandı. Uyku endoskopisi bulguları değerlendirildiğinde hafif grupta 6, orta
grupta 6 ve ağır grupta 4 hastada obstrüksiyon seviyesinde değişiklik olmazken diğer hastalarda obstrüksiyon seviye değişikliği saptanmıştır. Bu değişiklikler istatistiksel
olarak anlamlı bulunmuştur. Ayrıca hastalardaki obstrüksiyon paternleri de değerlendirilmiş, iki yöntem arasında istatistiksel olarak anlamlı değişim saptanmamıştır
(p<0.001).
Sonuç Son yıllarda obstrüksiyonun seviyesi ve paterninin değerlendirilmesi sonucu uygulanan tedavilerin daha başarılı olduğu bildirilmektedir. Üst solunum yolundaki kollaps az
sayıda hastada tek seviyede iken birçok hastada multipl seviyede saptanmaktadır. Uyku endoskopisi hava yolu obstrüksiyonunu dinamik olarak değerlendirebilmektedir.
Uyku endoskopisi ile fizyolojik uykuya yakın bir uyku elde edilerek belirlenen kollaps ve anatomik durum tedavi yönlendirmede son derece önemlidir ve uyanık yapılan
standart endoskopiye üstün olduğu bildirilmektedir. Hastaya anestezi verilmesi, sedasyon derinliğinin obstrüksiyon derecesini etkileyebilmesi ve sadece sırtüstü pozisyonda
yapılması uyku endoskopisinin dezavantajları olarak sayılabilir.

Keywords

Obstrüktif uyku apnesi, Uyku endoskopisi, NOHL klasifikasyonu, Obstrüksiyon paterni

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