title: Interventional Drug-Induced Sleep Endoscopy: A Novel Technique to Guide Surgical Planning for Obstructive Sleep Apnea.
abstract: OBJECTIVE
  One of the challenges of surgery for obstructive sleep apnea (OSA) is identifying the correct surgical site for each patient. The objective of this study was to use drug-induced sleep endoscopy (DISE) and nasopharyngeal tube (NPT) placement to determine the effect of eliminating palatal collapse on the obstruction seen on other segments of the upper airway.
  
  
  METHODS
  Forty-one OSA patients were enrolled in this prospective study. All patients had a polysomnogram followed by DISE. DISE findings were recorded and compared with and without placement of a NPT. Obstruction was graded with a scale that incorporates location, severity, and interval of obstruction.
  
  
  RESULTS
  Most patients (83%) demonstrated multilevel obstruction on initial DISE. With the nasopharyngeal airway in place, many patients with multilevel obstruction had at least a partial improvement (74%) and some a complete resolution (35%) of collapse (p < 0.05). Reduction in collapse was observed at the lateral walls (86%), epiglottis (55%), and tongue base (50%). NPT placement did not significantly alter upper airway morphology of patients with incomplete palatal obstruction or mild OSA.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to evaluate the effect of soft palatal stenting on downstream pharyngeal obstruction during DISE. Our study provides evidence that reducing soft palatal collapse can reduce negative pharyngeal pressure and thereby alleviate other sites of upper airway obstruction. Taken together, these findings provide a means to identify appropriate candidates for isolated palatal surgery and better direct a minimally invasive approach to the surgical management of OSA.
authors: Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX.
authors: Andrew Jacob
authors: AJ
authors: Victores
authors: Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX.
authors: Krista
authors: K
authors: Olson
authors: Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX.
authors: Masayoshi
authors: M
authors: Takashima
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D009666:Nose; D010159:Palate / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D011446:Prospective Studies; D012890:Sleep / Q000187:drug effects*; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives
keywords: DISE; OSA; drug-induced sleep endoscopy; nasopharyngeal tube; obstructive sleep apnea