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

Öz

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.

Anahtar Kelimeler

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

Obstrüktif Uyku Apnesi Hastalarında Obstruksiyon Lokalizasyonunun Uyku Endoskopisi ile Değerlendirilmesi

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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