title: Quantitative airway analysis during drug-induced sleep endoscopy for evaluation of sleep apnea.
abstract: OBJECTIVE
  To quantitatively measure changes in airway caliber at multiple anatomical levels during drug-induced sleep endoscopy (DISE) for evaluation of sleep apnea. We hypothesize that patients undergoing DISE will show: 1) collapse at multiple upper airway regions (retropalatal, retroglossal, and retroepiglottic), with greater collapse in the retropalatal region; and 2) greater anterior-posterior dimensional narrowing than the lateral.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Patients underwent DISE employing propofol as part of a nonrandomized prospective trial assessing candidacy for transoral robotic surgery intervention for sleep apnea. Images of the retropalatal, retroglossal, and retroepiglottic regions were captured during an initial period of light sedation and again in a period of deep sedation. Images were analyzed using software to measure the percent change in regional airway measurements as a result of DISE.
  
  
  RESULTS
  Thirty-seven sleep endoscopy videos were analyzed from patients with obstructive sleep apnea (apnea-hypopnea index: 42.9 ± 27.0 events/hour). Analyzable images were in the retropalatal (n = 24), retroglossal (n = 27), and retroepiglottic (n = 29) regions. The patients demonstrated mean reductions in airway area in the retropalatal (84.1 ± 18.7%), retroglossal (39.3 ± 37.5%), and retroepiglottic region (44.6 ± 42.8%). No statistically significant differences were found between lateral and anterior-posterior airway dimensional changes.
  
  
  CONCLUSIONS
  Patients undergoing DISE had significant reductions in airway area at multiple regions under deep sedation with propofol. We conclude that collapse in the retropalatal region is greater than the hypopharyngeal region. This method can be used to quantitatively measure DISE upper airway changes, which could potentially be used as a means for understanding surgical outcomes in patients with sleep apnea.
authors.affiliation: Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Borek
authors.forename: Erica R
authors.initials: ER
authors.lastname: Thaler
authors.forename: Christopher
authors.initials: C
authors.lastname: Kim
authors.forename: Nicholas
authors.initials: N
authors.lastname: Jackson
authors.forename: Jeff E
authors.initials: JE
authors.lastname: Mandel
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schwab
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D015203:Reproducibility of Results; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D014741:Video Recording
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol