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Comparison of sleep MRI and sleep endoscopy findings in patients with obstructive sleep apnea syndrome

Year 2019, , 255 - 261, 30.09.2019
https://doi.org/10.16899/jcm.608557

Abstract

OBJECTIVE: In
this study we aimed to compare the findings of  two methods which developed for the diagnosis
of obstructive pathology in patients with obstructive sleep apnea syndrome
(OSAS); sleep endoscopy and dynamic sleep magnetic resonance imaging (MRI) .

METHODS: A
total of 20 patients with OSAS (AHI> 5) were included in the study.
Anteroposterior (A-P) diameter and surface area measurements of uvulopalatal
region, retropalatal region and tongue root were performed by MRI in sleep and
wakefulness. The mean measurement of sleep and wakefulness were compared. In
these patients, sleep endoscopy (UE) was performed under operating room
conditions. The correlation of the obtained data was evaluated by statistical
methods.

RESULTS: There
was a statistically significant decrease in sleep MRI evaluation in all three
regions compared to measurements in awake position (p <0.001). The mean
diameter and surface area of the patients with UE occured at 50% or more at the
level of uvulopalatal and tongue root were statistically significantly lower
than those with less than 50% obstruction (p <0.05). Therefore, UE and Sleep
MRI data were interpreted as compatible with each other (p <0.05).







CONCLUSION: Similarity
of UE findings with sleep MRI findings, which is a more objective technique, is
important in terms of showing the effectiveness of UE. In addition, the UE is
more advantageous in that it can be applied with less equipment and allows
direct visualization of the pre-operative occlusion site.

References

  • 1- Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med 1976;27:465–84.
  • 2- Hudgel DW. Mechanisms of obstructive sleep apnea. Chest 1992;101:541–9.
  • 3- P.E. Peppard, T. Young, J.H. Barnet, M. Palta, E.W. Hagen, K.M. Hla, Increased Prevalence of Sleep-Disordered Breathing in Adults, Am. J. Epidemiol. 2013;177: 1006–14
  • 4- A.S. Jordan, D.G. McSharry, A.Malhotra.Adult obstructive sleep apnoea.Lancet.2014;383: 736–47.
  • 5- Rabelo FAW et al. Propofol-induced sleep: Polysomnographic evaluation of patients with obstructive sleep apnea and controls. Otolaryngol Head Neck Surg .2010;142: 218-24
  • 6- Croft CB, Pringle M Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol. Allied Sci. 1991;16:504–9
  • 7- Xiong YP, Yi HL, Yin SK et al. Predictors of surgical outcomes of uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome. Otolaryngol Head Neck Surg. 2011;7.
  • 8- Berry S, Roblin G, Williams A, Watkins A, Whittet HB. Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope. 2005;115:538-40
  • 9- Test-retest reliability of drug-induced sleep endoscopy. Rodriguez-Bruno K, Goldberg AN, McCulloch CE, Kezirian EJ. Otolaryngol Head Neck Surg. 2009;140:646-51.
  • 10- Barrera JE, Holbrook HS, Santos J, et al. Sleep MRI: novel technique to identify airway obstruction in obstructive sleep apnea. Otolaryngol-Head Neck Surg. 2009;140:423–5.
  • 11- The early postoperative course of surgical sleep apnea patients. Rotenberg B, Hu A, Fuller J, Bureau Y, Arra I, Sen M. Laryngoscope. 2010;120 :1063-8.
  • 12- Camilleri AE, Ramamurthy L, Jones PH. Sleep nasendoscopy: what benefit to the management of snorers?J Laryngol Otol. 1995;109:1163-5
  • 13- Keziran EJ, Weaver EM, Criswell MA, de Vries N, Woodson BT, Piccirillo JF. Reporting results of obstrutictive sleep apnes syndrome surgery trials. Otolaryngol-Head Neck Surg.2011;144:496-9.
  • 14- Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol.2011;268:1233–6
  • 15- den Herder C, van Tinteren H, de Vries N . Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring. Laryngoscope .2005;115:735–9
  • 16- Bachar G, FeinmEUSer R, Shpitzer T, Yaniv E, Nageris B, Eidelman L Laryngeal and hypopharyngeal obstruction in sleep disordered breathing patients, evaluated by sleep endoscopy .Eur Arch Otorhinolaryngol. 2008;265 :1397-402
  • 17- Steinhart H, Kuhn-Lohmann J, Gewalt K, Constantinidis J, MertzlufftF, Iro H. Upper airway collapsibility in habitual snorers and sleep apneics: evaluation withdrug-induced sleep endoscopy. ActaOtolaryngol. 2000;120:990-4
  • 18- Hill PD, Osman EZ, Osborne JE, Lee BW. Changes in snoring during natural sleep identified by acoustic crest factor analysis at different times of night.Clin Otolaryngol Allied Sci. 2000 ;25:507-10
  • 19- Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR.Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology.2005;103:470–7
  • 20- Suto Y, Matsuda E, Inoue Y. MRI of the pharynx in young patients with sleep disordered breathing. Br J Radiol. 1996;69:1000-4.
  • 21- Barrera JE, Chang RC, Popelka GR, Holbrook AB. Reliability of airway obstruction analyses from Sleep MRI sequences. Otolaryngol Head Neck Surg. 2010;142:526-30.
  • 22- Cosentini T, Le Donne R, Mancini D, Colavita N. Magnetic resonance imaging of the upper airway in obstructive sleep apnea. Radiol Med. 2004;108:404-16.
  • 23- Fleck RJ, Amin RS, Shott SR, Mahmoud MA. Int J Pediatr Otorhinolaryngol. MRI sleep studies: use of positive airway pressure support in patients with severe obstructive sleep apnea. 2014;78 :1163-6
  • 24- Moriwaki H, Inoue Y, Namba K, Suto Y, Chiba S, Moriyama H. Clinical significance of upper airway obstruction pattern during apneic episodes on ultrafast dynamic magnetic resonance imaging. Auris Nasus Larynx 2009; 36:187-91.
  • 25- Chong KB, De Vito A, Vicini C. Drug-Induced Sleep Endoscopy in Treatment Options Selection. Sleep Med Clin. 2019 ;14:33-40
  • 26- Lechner M, Wilkins D, Kotecha B. A review on drug-induced sedation endoscopy - Technique, grading systems and controversies. Sleep Med Rev. 2018;41:141-8

Tıkayıcı Uyku Apne Sendromlu Olgularda Uyku MRG Ve Uyku Endoskopisi Bulgularının Karşılaştırılması

Year 2019, , 255 - 261, 30.09.2019
https://doi.org/10.16899/jcm.608557

Abstract

AMAÇ:
Çalışmamızın amacı tıkayıcı uyku apne sendrom (TUAS) lu hastalarda üst solunum yolunda
ki tıkayıcı patolojilerin değerlendirilmesine yönelik olarak geliştirilmiş olan
iki yöntemin ; uyku endoskopisi(UE) ve uyku magnetik rezonans görüntüleme (MRG)
bulgularının değerlendirilmesi ve  karşılaştırılmasıdır.

GEREÇ
VE YÖNTEM:
Çalışmaya TUAS tanısı olan (AHI>5) toplam
20 hasta dahil edildi. Hastaların uyku ve uyanıklık halinde MRG ile  uvulopalatal bölge, retropalatal bölge ve dil
kökü seviyesinde anteroposterior(A-P) çap ve yüzey alan ölçümleri yapıldı. Uyku
ve uyanıklık halinde yapılan ölçüm ortalamaları karşılaştırıldı.Bu hastalara
ayrıca ameliyathane şartlarında uyku endoskopisi (UE) uygulanarak uvulopalatal,lateral
farengeal ve dil kökü bölgesinde tıkanıklık düzeyi yüzde üzerinden değerlendirildi.Elde
edilen verilerin korelasyonu istatiksel yöntemlerle değerlendirildi.

BULGULAR:  Uyku MRG
değerlendirilmesinde her üç bölgede de uyanık pozisyonda yapılan ölçümlere göre
istatiksel olarak anlamlı azalma görüldü(p<0.001). UE ile uvulopalatal ve
dil kökü düzeyinde %50 ve üzeri tıkanıklık gözlenen hastaların , çap ve yüzey
ölçüm alanları ortalaması %50 den az tıkanıklık saptanan hastalara göre
istatiksel olarak anlamlı düzeyde daha düşüktü (p<0.05). Bu nedenle UE ve
Uyku MRG yöntemlerinin verileri birbiri ile uyumlu olarak yorumlandı (p<0.05)







SONUÇ:
UE bulgularının  daha objektif bir teknik olan Uyku MRG
bulguları ile uyumlu olması, UE ‘nin etkinliğini göstermesi açısından önem
taşımaktadır. Bununla birlikte UE daha az ekipmanla uygulanabilmekte  ve 
operasyon öncesi tıkanıklığa yol açan bölgenin  direk görüntülemesine imkan tanımaktadır. 

References

  • 1- Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med 1976;27:465–84.
  • 2- Hudgel DW. Mechanisms of obstructive sleep apnea. Chest 1992;101:541–9.
  • 3- P.E. Peppard, T. Young, J.H. Barnet, M. Palta, E.W. Hagen, K.M. Hla, Increased Prevalence of Sleep-Disordered Breathing in Adults, Am. J. Epidemiol. 2013;177: 1006–14
  • 4- A.S. Jordan, D.G. McSharry, A.Malhotra.Adult obstructive sleep apnoea.Lancet.2014;383: 736–47.
  • 5- Rabelo FAW et al. Propofol-induced sleep: Polysomnographic evaluation of patients with obstructive sleep apnea and controls. Otolaryngol Head Neck Surg .2010;142: 218-24
  • 6- Croft CB, Pringle M Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol. Allied Sci. 1991;16:504–9
  • 7- Xiong YP, Yi HL, Yin SK et al. Predictors of surgical outcomes of uvulopalatopharyngoplasty for obstructive sleep apnea hypopnea syndrome. Otolaryngol Head Neck Surg. 2011;7.
  • 8- Berry S, Roblin G, Williams A, Watkins A, Whittet HB. Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope. 2005;115:538-40
  • 9- Test-retest reliability of drug-induced sleep endoscopy. Rodriguez-Bruno K, Goldberg AN, McCulloch CE, Kezirian EJ. Otolaryngol Head Neck Surg. 2009;140:646-51.
  • 10- Barrera JE, Holbrook HS, Santos J, et al. Sleep MRI: novel technique to identify airway obstruction in obstructive sleep apnea. Otolaryngol-Head Neck Surg. 2009;140:423–5.
  • 11- The early postoperative course of surgical sleep apnea patients. Rotenberg B, Hu A, Fuller J, Bureau Y, Arra I, Sen M. Laryngoscope. 2010;120 :1063-8.
  • 12- Camilleri AE, Ramamurthy L, Jones PH. Sleep nasendoscopy: what benefit to the management of snorers?J Laryngol Otol. 1995;109:1163-5
  • 13- Keziran EJ, Weaver EM, Criswell MA, de Vries N, Woodson BT, Piccirillo JF. Reporting results of obstrutictive sleep apnes syndrome surgery trials. Otolaryngol-Head Neck Surg.2011;144:496-9.
  • 14- Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol.2011;268:1233–6
  • 15- den Herder C, van Tinteren H, de Vries N . Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring. Laryngoscope .2005;115:735–9
  • 16- Bachar G, FeinmEUSer R, Shpitzer T, Yaniv E, Nageris B, Eidelman L Laryngeal and hypopharyngeal obstruction in sleep disordered breathing patients, evaluated by sleep endoscopy .Eur Arch Otorhinolaryngol. 2008;265 :1397-402
  • 17- Steinhart H, Kuhn-Lohmann J, Gewalt K, Constantinidis J, MertzlufftF, Iro H. Upper airway collapsibility in habitual snorers and sleep apneics: evaluation withdrug-induced sleep endoscopy. ActaOtolaryngol. 2000;120:990-4
  • 18- Hill PD, Osman EZ, Osborne JE, Lee BW. Changes in snoring during natural sleep identified by acoustic crest factor analysis at different times of night.Clin Otolaryngol Allied Sci. 2000 ;25:507-10
  • 19- Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR.Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology.2005;103:470–7
  • 20- Suto Y, Matsuda E, Inoue Y. MRI of the pharynx in young patients with sleep disordered breathing. Br J Radiol. 1996;69:1000-4.
  • 21- Barrera JE, Chang RC, Popelka GR, Holbrook AB. Reliability of airway obstruction analyses from Sleep MRI sequences. Otolaryngol Head Neck Surg. 2010;142:526-30.
  • 22- Cosentini T, Le Donne R, Mancini D, Colavita N. Magnetic resonance imaging of the upper airway in obstructive sleep apnea. Radiol Med. 2004;108:404-16.
  • 23- Fleck RJ, Amin RS, Shott SR, Mahmoud MA. Int J Pediatr Otorhinolaryngol. MRI sleep studies: use of positive airway pressure support in patients with severe obstructive sleep apnea. 2014;78 :1163-6
  • 24- Moriwaki H, Inoue Y, Namba K, Suto Y, Chiba S, Moriyama H. Clinical significance of upper airway obstruction pattern during apneic episodes on ultrafast dynamic magnetic resonance imaging. Auris Nasus Larynx 2009; 36:187-91.
  • 25- Chong KB, De Vito A, Vicini C. Drug-Induced Sleep Endoscopy in Treatment Options Selection. Sleep Med Clin. 2019 ;14:33-40
  • 26- Lechner M, Wilkins D, Kotecha B. A review on drug-induced sedation endoscopy - Technique, grading systems and controversies. Sleep Med Rev. 2018;41:141-8
There are 26 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Research
Authors

Volkan Çağlayan This is me 0000-0002-5448-1896

Müge Özçelik Korkmaz 0000-0003-4726-7987

Şenol Civelek This is me 0000-0002-9917-6254

Publication Date September 30, 2019
Acceptance Date July 23, 2019
Published in Issue Year 2019

Cite

AMA Çağlayan V, Özçelik Korkmaz M, Civelek Ş. Tıkayıcı Uyku Apne Sendromlu Olgularda Uyku MRG Ve Uyku Endoskopisi Bulgularının Karşılaştırılması. J Contemp Med. September 2019;9(3):255-261. doi:10.16899/jcm.608557