title: Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug-induced sleep endoscopy.
abstract: OBJECTIVE
  The primary objective of the study was to understand the differential impact of continuous positive airway pressure (CPAP) on the location, degree and pattern of airway collapse in obstructive sleep apnea (OSA) patients utilizing drug-induced sleep endoscopy (DISE).
  
  
  METHODS
  Non-randomized trial.
  
  
  METHODS
  University Medical Center.
  
  
  METHODS
  Fifteen consecutive OSA patients undergoing DISE.
  
  
  METHODS
  The patterns of airway collapse were videorecorded at baseline and under differential application of nasal CPAP (nCPAP) at 5, 10 and 15 cm H2O. For each modality, the pattern and degree of airway collapse were analyzed by three independent observers using the velum, oropharynx, tongue base, epiglottis (VOTE) classification system.
  
  
  RESULTS
  The modest nCPAP pressures (10 cm H2O) had the greatest impact on the lateral walls of the pharynx, followed by the palatal region. The collapsibility of the tongue base and epiglottis demonstrated significant resistance to nCPAP application, which was overcome by increasing nCPAP to 15 cm H2O. Compared to 5 cm H2O, nCPAP pressures of 10 and 15 cm H2O improved complete collapse at least at one level of the upper airway (P=.016 and .001, respectively). Increased nCPAP pressures also led to changes in the configuration of airway collapse at the level of the velum.
  
  
  CONCLUSIONS
  The differential nCPAP effects observed in this study may help to understand some of the mechanisms responsible for inadequate patient response and poor nCPAP compliance. The use of DISE in combination with CPAP may serve as a first step in optimizing patients that failed to adapt to treatment with CPAP. This approach can help the physician identify patterns of airway collapse that may require varying pressures different from the one the patient is using, as well as anatomical factors that may be corrected to help with compliance.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA.|Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.|Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: C
authors.identifier: http://orcid.org/0000-0003-0273-9901
authors.initials: C
authors.lastname: Torre
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: S Y
authors.initials: SY
authors.lastname: Liu
authors.affiliation: Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Kushida
authors.affiliation: Department of Anesthesia, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: V
authors.initials: V
authors.lastname: Nekhendzy
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Cathay General Hospital, Taipei, Taiwan.|School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: L K
authors.initials: LK
authors.lastname: Huon
authors.affiliation: Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Capasso
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D045422:Continuous Positive Airway Pressure; D004724:Endoscopy; D004825:Epiglottis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000000981:diagnostic imaging; D010160:Palate, Soft / Q000000981:diagnostic imaging; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D014059:Tongue / Q000000981:diagnostic imaging; D016896:Treatment Outcome
keywords: VOTE system; continuous positive airway pressure; drug-induced sleep endoscopy; epiglottis; hypopharynx; lateral pharyngeal walls; obstructive sleep apnoea; palate; tongue base