title: Drug-induced sleep endoscopy in the obstructive sleep apnea: comparison between NOHL and VOTE classifications.
abstract: Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete collapse of the pharynx that result in a decrease in oxyhemoglobin saturation. Nasofibrolaryngoscopy under induced sleep is a promising alternative for identifying sites of upper airway obstruction in patients with OSA. This study aimed to compare the obstruction sites screened by drug-induced sleep endoscopy (DISE) using the Nose oropharynx hypopharynx and larynx (NOHL) and Velum oropharynx tongue base epiglottis (VOTE) classifications. We also determined the relationship between OSA severity and the number of obstruction sites and compared the minimum SaO2levels between DISE and polysomnography (PSG). This was a prospective study in 45 patients with moderate and severe OSA using DISE with target-controlled infusion of propofol bispectral index (BIS) monitoring. The retropalatal region was the most frequent obstruction site, followed by the retrolingual region. Forty-two percent of patients had obstruction in the epiglottis. Concentrically shaped obstructions were more prevalent in both ratings. The relationship between OSA severity and number of obstruction sites was significant for the VOTE classification. Similar minimum SaO2values were observed in DISE and PSG. The VOTE classification was more comprehensive in the analysis of the epiglottis and pharynx by DISE and the relationship between OSA severity and number of affected sites was also established by VOTE. The use of BIS associated with DISE is a reliable tool for the assessment of OSA patients.
authors.affiliation: Graduate Program of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil. aloncovianajr@gmail.com.|Otorhinolaryngology Department, Marcílio Dias Naval Hospital, Cezar Zania,138, Lins de Vasconcelos, Rio de Janeiro, 20725-090, Rio de Janeiro, Brazil. aloncovianajr@gmail.com.
authors.forename: Alonço
authors.initials: A
authors.lastname: da Cunha Viana
authors.affiliation: Otorhinolaryngology Department, Marcílio Dias Naval Hospital, Cezar Zania,138, Lins de Vasconcelos, Rio de Janeiro, 20725-090, Rio de Janeiro, Brazil.
authors.forename: Daniella Leitão
authors.initials: DL
authors.lastname: Mendes
authors.affiliation: Otorhinolaryngology Department, University of the State of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
authors.forename: Lucas Neves
authors.initials: LN
authors.lastname: de Andrade Lemes
authors.affiliation: Graduate Program of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.|Clinical Research Coordination at the National Cancer Institute (INCA), Rio de Janeiro, Brazil.
authors.forename: Luiz Claudio Santos
authors.initials: LC
authors.lastname: Thuler
authors.affiliation: Graduate Program of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.|Cardiopulmonary Department, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
authors.forename: Denise Duprat
authors.initials: DD
authors.lastname: Neves
authors.affiliation: Graduate Program of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.|Otorhinolaryngology Department, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
authors.forename: Maria Helena
authors.initials: MH
authors.lastname: de Araújo-Melo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007830:Larynx / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology; D017286:Polysomnography; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000145:classification* / Q000175:diagnosis / Q000503:physiopathology; D055815:Young Adult
keywords: BIS; Endoscopy; Obstructive sleep apnea; Pharynx; Propofol; Sleep