Araştırma Makalesi
BibTex RIS Kaynak Göster

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

Yıl 2021, Cilt: 1 Sayı: 1, 5 - 10, 16.12.2021
https://doi.org/10.29228/HMJ.2

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.

Kaynakça

  • 1. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217-39.
  • 2. Stradling JR, Davies RJ. Sleep. 1: Obstructive sleep apnea/hypopnea syndrome: definitions, epidemiology, and natural history. Thorax 2004;59:73-8.
  • 3. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53.
  • 4. De Corso E, Fiorita A, Rizzotto G, et al. The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnoea syndrome: our personal experience. Acta Otorhinolaryngol Ital 2013;33:405-13.
  • 5. Croft CB, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 1991;16:504-9.
  • 6. Vicini C, De Vito A, Benazzo M, et al. The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients. Eur Arch Otorhinolaryngol 2012;269:1297-300.
  • 7. Mallampati S, Gatt S, Gugino L, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429-34.
  • 8. Cavaliere M, Russo F, Iemma M. Awake versus drug-ınduced sleep endoscopy: Evaluation of airway obstruction in obstructive sleep apnea/hypopnoea syndrome. Laryngoscope 2013;123:2315-8.
  • 9. Borowiecki B, Pollak CP, Weitzman ED, Rakoff S, Imperato J. Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleepapnea syndrome. Laryngoscope 1978; 88:1310-3.
  • 10. Rabelo FA, Küpper DS, Sander HH, et al. A comparison of the Fujita classification of awake and drug-induced sleep endoscopy patients. Braz J Otorhinolaryngol 2013;79:100-5.
  • 11. Koo SK, Choi JW, Myung NS Lee H, Kim YJ, Kim YJ. Analysis of obstruction site in obstructive sleep apnea syndrome patients by drug induced sleep endoscopy. Am J Otolaryngol 2013;34:626-30.
  • 12. Hamans E, Meeus O, Boudewyns A, Saldien V, Verbraecken J, Van de Heyning P. Outcome of sleep endoscopy in obstructive sleep apnea: the Antwerp experience. B-ENT 2010;6:97-103.
  • 13. Vroegop AV, Vanderveken OM, Boudewyns AN, et al. Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope 2014;24:797-802.
  • 14. Sher AE, Scnehtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19:156-77.
  • 15. Braga A, Carboni LH, do Lago T, Küpper DS, Eckeli A, Valera FC. Is uvulopalatipharyngoplasty still an option for the treatment of obstructive sleep apnea? Eur Arch Otorhinolaryngol. 2013;270:549-54.
  • 16. Camilleri AE, Ramamurthy L, Jones PH. Sleep nasendoscopy: what benefit to the management of snorers? J Laryngol Otol 1995;109:1163-5.
  • 17. Li W, Ni D, Jiang H, Zhang L. Predictive value of sleep nasendoscopy and the Müller maneuver in uvulopalatopharyngoplasty for the obstructive sleep apnea syndrome. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2003;17:145-6.
  • 18. Stuck BA, Maurer JT. Airway evaluation in obstructive sleep apnea. Sleep Med Rev 2008;12:411-36.
  • 19. Victores AJ, Hamblin J, Gilbert J, Switzer C, Takashima M. Usefulness of sleep endoscopy in predicting positional obstructive sleep apnea. Otolaryngol Head Neck Surg 2014;150:487-93.
  • 20. Kezirian EJ, White DP, Malhotra A, Ma W, McCulloch CE, Goldberg AN. Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 2010;136:393-7.
  • 21. Campanini A, Canzi P, De Vito A, Dallan I, Montevecchi F, Vicini C. Awake versus sleep endoscopy: personal experience in 250 OSAHS patients. Acta Otorhinolaryngol Ital 2010;30:73-7.
  • 22. Gregório MG, Jacomelli M, Figueiredo AC, Cahali MB, Pedreira WL Jr, Lorenzi Filho G. Evaluation of airway obstruction by nasopharyngoscopy: comparison of the Müller maneuver versus induced sleep. Braz J Otorhinolaryngol 2007;73:618-22.

Obstrüktif Uyku Apnesi Hastalarında Obstruksiyon Lokalizasyonunun Uyku Endoskopisi ile Değerlendirilmesi

Yıl 2021, Cilt: 1 Sayı: 1, 5 - 10, 16.12.2021
https://doi.org/10.29228/HMJ.2

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.

Kaynakça

  • 1. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002;165:1217-39.
  • 2. Stradling JR, Davies RJ. Sleep. 1: Obstructive sleep apnea/hypopnea syndrome: definitions, epidemiology, and natural history. Thorax 2004;59:73-8.
  • 3. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53.
  • 4. De Corso E, Fiorita A, Rizzotto G, et al. The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnoea syndrome: our personal experience. Acta Otorhinolaryngol Ital 2013;33:405-13.
  • 5. Croft CB, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 1991;16:504-9.
  • 6. Vicini C, De Vito A, Benazzo M, et al. The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients. Eur Arch Otorhinolaryngol 2012;269:1297-300.
  • 7. Mallampati S, Gatt S, Gugino L, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32:429-34.
  • 8. Cavaliere M, Russo F, Iemma M. Awake versus drug-ınduced sleep endoscopy: Evaluation of airway obstruction in obstructive sleep apnea/hypopnoea syndrome. Laryngoscope 2013;123:2315-8.
  • 9. Borowiecki B, Pollak CP, Weitzman ED, Rakoff S, Imperato J. Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleepapnea syndrome. Laryngoscope 1978; 88:1310-3.
  • 10. Rabelo FA, Küpper DS, Sander HH, et al. A comparison of the Fujita classification of awake and drug-induced sleep endoscopy patients. Braz J Otorhinolaryngol 2013;79:100-5.
  • 11. Koo SK, Choi JW, Myung NS Lee H, Kim YJ, Kim YJ. Analysis of obstruction site in obstructive sleep apnea syndrome patients by drug induced sleep endoscopy. Am J Otolaryngol 2013;34:626-30.
  • 12. Hamans E, Meeus O, Boudewyns A, Saldien V, Verbraecken J, Van de Heyning P. Outcome of sleep endoscopy in obstructive sleep apnea: the Antwerp experience. B-ENT 2010;6:97-103.
  • 13. Vroegop AV, Vanderveken OM, Boudewyns AN, et al. Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope 2014;24:797-802.
  • 14. Sher AE, Scnehtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 1996;19:156-77.
  • 15. Braga A, Carboni LH, do Lago T, Küpper DS, Eckeli A, Valera FC. Is uvulopalatipharyngoplasty still an option for the treatment of obstructive sleep apnea? Eur Arch Otorhinolaryngol. 2013;270:549-54.
  • 16. Camilleri AE, Ramamurthy L, Jones PH. Sleep nasendoscopy: what benefit to the management of snorers? J Laryngol Otol 1995;109:1163-5.
  • 17. Li W, Ni D, Jiang H, Zhang L. Predictive value of sleep nasendoscopy and the Müller maneuver in uvulopalatopharyngoplasty for the obstructive sleep apnea syndrome. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2003;17:145-6.
  • 18. Stuck BA, Maurer JT. Airway evaluation in obstructive sleep apnea. Sleep Med Rev 2008;12:411-36.
  • 19. Victores AJ, Hamblin J, Gilbert J, Switzer C, Takashima M. Usefulness of sleep endoscopy in predicting positional obstructive sleep apnea. Otolaryngol Head Neck Surg 2014;150:487-93.
  • 20. Kezirian EJ, White DP, Malhotra A, Ma W, McCulloch CE, Goldberg AN. Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 2010;136:393-7.
  • 21. Campanini A, Canzi P, De Vito A, Dallan I, Montevecchi F, Vicini C. Awake versus sleep endoscopy: personal experience in 250 OSAHS patients. Acta Otorhinolaryngol Ital 2010;30:73-7.
  • 22. Gregório MG, Jacomelli M, Figueiredo AC, Cahali MB, Pedreira WL Jr, Lorenzi Filho G. Evaluation of airway obstruction by nasopharyngoscopy: comparison of the Müller maneuver versus induced sleep. Braz J Otorhinolaryngol 2007;73:618-22.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Kulak Burun Boğaz
Bölüm Araştırma Makaleleri
Yazarlar

Mümtaz Taner Torun 0000-0002-5194-4234

Yayımlanma Tarihi 16 Aralık 2021
Gönderilme Tarihi 11 Kasım 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 1 Sayı: 1

Kaynak Göster

Vancouver Torun MT. Obstrüktif Uyku Apnesi Hastalarında Obstruksiyon Lokalizasyonunun Uyku Endoskopisi ile Değerlendirilmesi. HTD / HMJ. 2021;1(1):5-10.

e-ISSN: 2791-9935