THE CONNECTION BETWEEN POLYSOMNOGRAPHY RESULTS, EPWORTH SCORES AND DRUG-INDUCED SLEEP ENDOSCOPY FINDINGS IN PATIENTS WITH OSAS

Abstract

Objective: To determine the usefulness of drug-induced sleep endoscopy (DISE) and evaluate correlations between DISE findings, polysomnography and Epworth sleepiness scale values. Material and Method: Included in this study are patients with major OSAS symptoms and apnea-hypopnea index (AHI) values between 5 and 30 who were scheduled for soft palate surgery. The patients were sedated with propofol (0.25 cc/kg) in the operating room for examination of obstructive regions. Anatomical structures affected by obstruction were observed with flexible endoscopy. The images from this examination were analyzed with Ulead video study. Patients with soft palate pathologies were operated and the endoscopic examination repeated postoperatively. Changes in pre- and post-operative obstruction areas were compared with changes in pre- and post-op PSG and Epworth sleepiness scale values. Results: Changes in retropalatal area values were correlated with changes in AHI values. The most important factor affecting this correlation was the formation of base of tongue pathology, despite being absent preoperatively. We also determined the correlation between patients’ Epworth scores, AHI and retropalatal area. Changes in the retropalatal area following OSAS surgery were correlated with changes in AHI and Epworth scores. Conclusion: DISE is an effective diagnostic technique in OSAS with advantages such as a low radiation risk, cost effectiveness and precise findings.

Keywords

• Drug-induced sleep endoscopy
• Obstructive sleep apnea
• Epworth sleepiness scale

OUAS HASTALARINDA İLAÇLA İNDÜKLENMİŞ UYKU ENDOSKOPİSİ BULGULARININ POLİSOMNOGRAFİ VE EPWORTH SKALASI SONUÇLARI İLE İLİŞKİSİ

Abstract

Amaç: Bu çalışmada tıkayıcı uyku apnesi sendromlu (TUAS) hastalarda ilaçla indüklenmiş uyku endoskopisinin (İİUE) önemini ortaya koymak ve İİUE bulguları ile polisomnografi ve Epworth uyku skalası sonuçları arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: Çalışma prospektif olarak planlandı. Çalışmaya major TUAS semptomlarına sahip, apne-hipopne indeksi (AHI) 5 ile 30 arasında olan ve yumuşak damak cerrahisi adayı olan hastalar dahil edildi. Hastalar tıkayıcı lezyonun muayenesi için ameliyathane şartlarında propofol ile (0,25 cc/kg) sedatize edildi. Tıkanma sonucu etkilenen anatomic yapılar fleksible endoskop ile araştırıldı. Bu muayene sonucu elde edilen görüntü Ulead video study programı ile analiz edildi. Yumuşak damak patolojisi olan hastalar opere edilerek operayon sonrası endoskopi işlemi tekrarlandı. Operasyon öncesi ve sonrası tıkanma alanlarındaki değişim ile polisomnografi ve Epworth skalasındaki değişimler karşılaştırıldı. Bulgular: Retropalatal alandaki değişim ile AHI değişimi korele idi. Bu korelasyonu en fazla etkileyen faktör operasyon öncesi olmayan dil kökü patolojisinin ortaya çıkması idi. Ayrıca Epworth skorları ile AHI ve retropalatal alan arasında da korelasyon tespit ettik. TUAS cerrahisi sonrası retropalatal alandaki değişim AHI ve Epworth skorundaki değişim ile korele olarak tespit edildi. Sonuç: İİUE, TUAS hastalarında düşük radyasyon riski, ucuz olması ve değerli verileri sayesinde etkili bir tanı tekniğidir.

Keywords

• İlaç ile indüklenmiş uyku endoskopisi
• tıkayıcı uyku apnesi
• Epworth uyku skalası

References

1. 1. Kokturk O. Breathing disturbances in sleep: history, definition, spectrum and dimension of the disease (in Turkish). Tüberküloz ve Toraks 1998;46:187-92.
2. 2. Amos JM, Durr ML, Nardone HC, Baldassari CM, Duggins A, Ishman SL. Systematic review of drug-induced sleep endoscopy scoring systems. Otolaryngol Head Neck Surg 2018;158(2):240-8. [CrossRef]
3. 3. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-5. [CrossRef]
4. 4. Croft CB, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol 1990;16:504-9. [CrossRef]
5. 5. Storesund A, Johansson A, Bjorvatn B, Lehmann S. Oral appliance treatment outcome can be predicted by continuous positive airway pressure in moderate to severe obstructive sleep apnea. Sleep Breath 2018;22(2):385-92. [CrossRef]
6. 6. Ko MT, Su CY. Computer-assisted quantitative evaluation of obstructive sleep apnea using digitalized endoscopic imaging with Muller maneuver. Laryngoscope 2008;118:90914. [CrossRef]
7. 7. Lovato A, Kotecha B, Vianello A, Giacomelli L, Staffieri A, Marchese-Ragona R. Nasal and oral snoring endoscopy: novel and promising diagnostic tools in OSAS patients. Eur Arch Otorhinolaryngol 2015;272(7):1793-9. [CrossRef]
8. 8. Zerpa Zerpa V, Carrasco Llatas M, Agostini Porras G, Dalmau Galofre J. Drug-induced sedation endoscopy versus clinical exploration for the diagnosis of severe upper airway obstruction in OSAS patients. Sleep Breath 2015;19(4):1367-72. [CrossRef]

9. 9. Sakat MS, Sütbeyaz Y, Yüceler Z, Kantarci M, Kilic K, Kurt S. Cephalometric Measurements with Multislice Computed Tomography in Patients with Obstructive Sleep Apnea Syndrome. J Craniofac Surg 2016;27(1):82-6. [CrossRef]
10. 10. Wang Y, Sun C, Cui X, Guo Y, Wang Q, Liang H. The role of drug-induced sleep endoscopy: predicting and guiding upper airway surgery for adult OSA patients. Sleep Breath 2018;22(4):925-31. [CrossRef]
11. 11. Belgü AU, Erdoğan B, San T, Gürkan E. The relationship between AHI, Epworth scores and sleep endoscopy in patients with OSAS. Eur Arch Otorhinolaryngol 2015;272(1):241-5. [CrossRef]
12. 12. Viana Ada C Jr, Thuler LC, Araújo-Melo MH. Drug-induced sleep endoscopy in the identification of obstruction sites in patients with obstructive sleep apnea: a systematic review. Braz J Otorhinolaryngol 2015;81(4):439-46. [CrossRef]
13. 13. Salamanca F, Costantini F, Bianchi A, Amaina T, Colombo E, Zibordi F. Identification of obstructive sites and patterns in obstructive sleep apnea syndrome by sleep endoscopy in 614 patients. Acta Otorhinolaryngol Ital 2013;33:261-6.