SESSION TITLE: OSA Posters
SESSION TYPE: Poster Presentations
PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM
PURPOSE: Drug Induced Sleep Endoscopy (DISE) is a technique used to evaluate the point of airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) in order to plan corrective surgery. The standard treatment for OSAS is nasal continuous positive airway pressure (CPAP), but there are a small percentage of patients that do not respond to CPAP and maintaining high apnea-hypopnea index (AHI). Aims: Evaluate upper airway alterations in spontaneous ventilation and with noninvasive ventilation (NIV) through DISE in OSAS nonresponders patients to NIV.
METHODS: Prospective study with patients diagnosed with OSAS nonresponders to NIV, between September/2011 and March/2013. We performed a laryngoscopy with awake patient and subsequently sedated in spontaneously breathing and with NIV. Recorded findings included the presence and degree of obstruction in the palatal and hypopharyngeal regions and the contributions of specific structures to upper airway obstruction.
RESULTS: Six nonresponders underwent DISE examinations. Mean age was 67.0years and one patient was female. On diagnostic sleep studies, the mean AHI was 46.3 events/hour. All patients initiated NIV with Auto-CPAP and changed to BiPAP mode but persisted high AHI. During DISE, a majority of subjects demonstrated palatal and oropharyngeal side walls obstruction during sedation with spontaneous ventilation. With NIV occurred worsening of airway obstruction induced by flapping epiglottis (n=3), drop of the tongue (n=1), uvula obstruction (n=1) and persistent hypopharyng obstruction despite increasing of ventilatory pressure (n=1). Four patients were proposed to uvulopalatopharyngoplasty and weight loss, one patient change to autoBiPAP mode and two patients initiated postural changes (manual hiperextension neck and elevation of the head).
CONCLUSIONS: Drug induced sleep endoscopy should be performed with spontaneous ventilation and with NIV in OSAS refractory treatment. There are inherent pathophysiological factors in NIV mechanics which may exacerbate the obstructive events. The rare complications and contraindications of this technique show that it a safe technique and an asset to the study of OSAS patients.
CLINICAL IMPLICATIONS: Drug induced sleep endoscopy should be performed with spontaneous ventilation and with NIV in OSAS refractory treatment. There are inherent pathophysiological factors in NIV mechanics which may exacerbate the obstructive events.
DISCLOSURE: The following authors have nothing to disclose: Ines Sanches, Catarina Ferreira, Ana Bernardino, João Elói, Vitória Martins, Fátima Teixeira, José Moutinho dos Santos
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