title: Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea.
abstract: OBJECTIVE
  To study the possible predictive value of drug-induced sleep endoscopy (DISE) in assessing therapeutic response to implanted upper airway stimulation (UAS) for obstructive sleep apnea (OSA).
  
  
  METHODS
  During DISE, artificial sleep is induced by midazolam and/or propofol, and the pharyngeal collapse patterns are visualized using a flexible fiberoptic nasopharyngoscope. The level (palate, oropharynx, tongue base, hypopharynx/epiglottis), the direction (anteroposterior, concentric, lateral), and the degree of collapse (none, partial, or complete) were scored in a standard fashion.
  
  
  RESULTS
  We report on the correlation between DISE results and therapy response in 21 OSA patients (apnea-hypopnea index [AHI] 38.5 ± 11.8/h; body mass index [BMI] 28 ± 2 kg/m(2), age 55 ± 11 y, 20 male/1 female) who underwent DISE before implantation of a UAS system. Statistical analysis revealed a significantly better outcome with UAS in patients (n = 16) without palatal complete concentric collapse (CCC), reducing AHI from 37.6 ± 11.4/h at baseline to 11.1 ± 12.0/h with UAS (p < 0.001). No statistical difference was noted in AHI or BMI at baseline between the patients with and without palatal CCC. In addition, no predictive value was found for the other DISE collapse patterns documented.
  
  
  CONCLUSIONS
  The absence of palatal CCC during DISE may predict therapeutic success with implanted UAS therapy. DISE can be recommended as a patient selection tool for implanted UAS to treat OSA.
authors.affiliation: Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium. olivier.vanderveken@uza.be
authors.forename: Olivier M
authors.initials: OM
authors.lastname: Vanderveken
authors.forename: Joachim T
authors.initials: JT
authors.lastname: Maurer
authors.forename: Winfried
authors.initials: W
authors.lastname: Hohenhorst
authors.forename: Evert
authors.initials: E
authors.lastname: Hamans
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Lin
authors.forename: Anneclaire V
authors.initials: AV
authors.lastname: Vroegop
authors.forename: Clemens
authors.initials: C
authors.lastname: Anders
authors.forename: Nico
authors.initials: N
authors.lastname: de Vries
authors.forename: Paul H
authors.initials: PH
authors.lastname: Van de Heyning
mesh_terms: D000402:Airway Obstruction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D004558:Electric Stimulation / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007002:Hypoglossal Nerve / Q000601:surgery*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D018579:Patient Selection; D010614:Pharynx / Q000503:physiopathology; D017286:Polysomnography / Q000379:methods; D015742:Propofol / Q000008:administration & dosage; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol
keywords: Electrical stimulation; hypoglossal nerve; neuromodulation; obstructive sleep apnea hypopnea syndrome; prediction; sleep disordered breathing; snoring