title: Technique and Preliminary Analysis of Drug-Induced Sleep Endoscopy With Online Polygraphic Cardiorespiratory Monitoring in Patients With Obstructive Sleep Apnea Syndrome.
abstract: Drug-induced sleep endoscopy is a diagnostic technique that allows dynamic evaluation of the upper airway during artificial sleep. The lack of a standardized procedure and the difficulties associated with direct visual detection of obstructive events result in poor intraobserver and interobserver reliability, especially when otolaryngology surgeons not experienced in the technique are involved.
  
  
  
  To describe a drug-induced sleep endoscopy technique implemented with simultaneous polygraphic monitoring of cardiorespiratory parameters (DISE-PG) in patients with a diagnosis of obstructive sleep apnea syndrome and discuss the technique's possible advantages compared with the standard procedure.
  
  
  
  This prospective cohort study included 50 consecutive patients with obstructive sleep apnea syndrome who underwent DISE-PG from March 1, 2013, to June 30, 2014. A standard protocol was adopted, and all the procedures were carried out in an operation room by an experienced otolaryngology surgeon under the supervision of an anesthesiologist. Endoscopic and polygraphic obstructive respiratory events were analyzed offline in a double-blind setting and randomized order.
  
  
  
  The feasibility and safety of the DISE-PG technique, as well as its sensitivity in detecting respiratory events compared with that of the standard drug-induced sleep endoscopy procedure.
  
  
  
  All 50 patients (43 men and 7 women; mean [SD] age, 51.1 [12.1] years) underwent DISE-PG without technical problems or patient difficulties regarding the procedure. As expected, polygraphic scoring was more sensitive than endoscopic scoring in identifying obstructive events (mean [SD] total events, 13.3 [6.8] vs 5.3 [3.6]; mean [SD] difference, 8.8 [5.6]; 95% CI, 7.3 to 10.4; Cohen d, -1.5). This difference was most pronounced in patients with a higher apnea-hypopnea index (AHI) at baseline (mean [SD] difference for AHI >30, 27.1% [31.0%]; 95% CI, -36.2% to 90.4%; Cohen d, 0.2; for AH I >40, 76.0% [35.5%]; 95% CI, 4.6% to 147.4%; Cohen d, 0.5; for AHI >50, 92.2% [37.2%]; 95% CI, 17.3% to 167.1%; Cohen d, 0.6) and a high percentage of hypopneas (≥75% of all obstructive events) at baseline (mean [SD] difference, 20.2% [5.4%]; 95% CI, 9.2% to 31.3%; Cohen d, 1.1). No other anthropomorphic or polygraphic features at baseline were associated with the differences between the DISE-PG and baseline home sleep apnea test.
  
  
  
  The DISE-PG technique is feasible, safe, and more sensitive at detecting an obstructed breathing pattern than is drug-induced sleep endoscopy alone. The DISE-PG technique could be helpful for accurate comprehension of upper airway obstructive dynamics (ie, degree of obstruction and multilevel pattern) and a nonobstructive breathing pattern (ie, central apneas).
authors.affiliation: Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gobbi
authors.affiliation: Neurology Unit, Department of Head, Neck and Sensory System, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy3Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Baiardi
authors.affiliation: Neurology Unit, Department of Head, Neck and Sensory System, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Mondini
authors.affiliation: Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cerritelli
authors.affiliation: Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Piccin
authors.affiliation: private practice, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scaramuzzino
authors.affiliation: private practice, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Milano
authors.affiliation: Anesthesia and Intensive Care Unit, Department of Surgical and Anesthesiological Sciences, University of Bologna, Bologna, Italy.
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Melotti
authors.affiliation: Anesthesia and Intensive Care Unit, Department of Surgical and Anesthesiological Sciences, University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mordini
authors.affiliation: Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pirodda
authors.affiliation: Neurology Unit, Department of Head, Neck and Sensory System, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy3Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Cirignotta
authors.affiliation: Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sorrenti
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D017286:Polysomnography; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D014741:Video Recording
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol