Sleep Endoscopy with Positive Airway Pressure: A Method for Better Compliance and Individualized Treatment of Patients with Obstructive Sleep Apnea
Michaela Masárová,
Petr Matoušek,
Ondřej Jor,
Vilém Novák,
Adéla Vrtková,
Vojtěch Kubec,
Karol Zeleník,
Pavel Komínek,
Martin Formánek
Affiliations
Michaela Masárová
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
Petr Matoušek
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
Ondřej Jor
Department of Anesthesiology, Resuscitation and Intensive Medicine, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
Vilém Novák
Department of Pediatric Neurology, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
Adéla Vrtková
Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 708 00 Ostrava, Czech Republic
Vojtěch Kubec
Department of Otorhinolaryngology, Faculty of Medicine in Pilsen, University Hospital in Pilsen, Charles University, 305 99 Pilsen, Czech Republic
Karol Zeleník
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
Pavel Komínek
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
Martin Formánek
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 708 52 Ostrava, Czech Republic
In this study, we aimed to observe the effects of positive airway pressure (PAP) on individual levels of obstruction during drug-induced sleep endoscopy (DISE) of the upper airways (UA), to evaluate at which pressures the obstruction disappeared or worsened, and to identify cases in which PAP was ineffective. This prospective study was conducted from June 2018 to June 2022. PAP testing was performed during DISE in patients with moderate and severe OSA. The pressure was gradually increased over the range from 6.0 to 18.0 hPa. Our findings were evaluated using the VOTE classification. The examination was performed in 56 patients, with a median apnea–hypopnea index (AHI) of 26.4. Complete obstruction of the soft palate was observed in 51/56 patients (91%), oropharyngeal obstruction in 15/56 patients (27%), tongue base obstruction in 23/56 patients (41%), and epiglottic collapse in 16/56 patients (29%). PAP was most effective in cases of complete oropharyngeal obstruction, and least effective in cases of epiglottic collapse, where it was ineffective in 11/16 patients. DISE with PAP is a simple diagnostic method that can be helpful for identifying anatomic and dynamic reasons for PAP intolerance. The main indication is ineffective PAP treatment.
