title: Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system.
abstract: BACKGROUND
  Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with Obstructive Sleep Apnea Syndrome (OSAS). To this end, several diagnostic tests and procedures have been developed.
  
  
  OBJECTIVE
  To determine whether drug-induced sleep endoscopy (DISE) or Müller's maneuver (MM) would be more successful at identifying the site of obstruction and the pattern of upper airway collapse in patients with OSAS.
  
  
  METHODS
  The study included 63 patients (52 male and 11 female) who were diagnosed with OSAS at our clinic. Ages ranged from 30 to 66 years old and the average age was 48.5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction as well as the VOTE classification. The results of each test were analyzed per upper airway level and compared using statistical analysis (Cohen's kappa statistic test).
  
  
  RESULTS
  There was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior (73%), lateral (92.1%), and concentric (74.6%) configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests (58.7%). Results from the lateral configuration of the epiglottis were in concordance between the tests (87.3%). There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue (23.8%) and epiglottis (42.9%).
  
  
  CONCLUSIONS
  We suggest that DISE has several advantages including safety, ease of use, and reliability, which outweigh MM in terms of the ability to diagnose sites of obstruction and the pattern of upper airway collapse. Also, MM can provide some knowledge of the pattern of pharyngeal collapse. Furthermore, we also recommend using the VOTE classification in combination with DISE.
authors.affiliation: Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey.
authors.forename: Yakup
authors.initials: Y
authors.lastname: Yegïn
authors.affiliation: Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey. Electronic address: dr.mcelik@yahoo.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Çelik
authors.affiliation: Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey.
authors.forename: Kamïl Hakan
authors.initials: KH
authors.lastname: Kaya
authors.affiliation: Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey.
authors.forename: Arzu Karaman
authors.initials: AK
authors.lastname: Koç
authors.affiliation: Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul, Turkey.
authors.forename: Fatma Tülin
authors.initials: FT
authors.lastname: Kayhan
mesh_terms: D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*
chemical_list: D018686:Anesthetics, Intravenous
keywords: Apneia obstrutiva do sono; Classificação VOTE; Drug-induced sleep endoscopy; Endoscopia com sono induzido por fármacos; Manobra de Müller; Müller's maneuver; Obstructive sleep apnea; VOTE classification