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Comparative Study
. 2013 Jan;148(1):151-6.
doi: 10.1177/0194599812460505. Epub 2012 Sep 11.

Drug-induced sleep endoscopy vs awake Müller's maneuver in the diagnosis of severe upper airway obstruction

Danny Soares  1 , Adam J Folbe, George Yoo, M Safwan Badr, James A Rowley, Ho-Sheng Lin
Affiliations
Comparative Study

Drug-induced sleep endoscopy vs awake Müller's maneuver in the diagnosis of severe upper airway obstruction

Danny Soares et al. Otolaryngol Head Neck Surg. 2013 Jan.

Abstract

Objective: To compare fiber-optic nasal endoscopy with Müller's maneuver (FNMM) against drug-induced sleep endoscopy (DISE) in diagnosing the presence of severe level-specific upper airway collapse in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS).

Study design: Case series with chart review.

Setting: Tertiary care academic center.

Subjects and methods: Medical records of all adult patients undergoing diagnostic DISE as part of their surgical evaluation were reviewed. Patients were included if they had undergone FNMM and had documented Friedman tongue position and tonsillar grade prior to DISE. Airway obstruction on both endoscopic procedures was described according to airway level and severity. Severe airway obstruction was defined as >75% collapse on endoscopy.

Results: Fifty-three patients were included in this study. Fiber-optic nasal endoscopy with Müller's maneuver and DISE did not differ significantly regarding the presence of severe retropalatal airway collapse. There was a statistically significant difference in the incidence of severe retrolingual collapse identified via DISE (84.9% [45/53]) compared with FNMM (35.8% [19/53]; P < .0001). This discrepancy between FNMM and DISE findings was statistically significant in individuals with Friedman I and II tongue positions (FNMM = 16.7%, DISE = 88.9%, P < .0001) and individuals with Friedman III tongue position (FNMM = 31.8%, DISE = 81.8%, P = .002). Patients with Friedman IV showed no significant difference (P = .65) between FNMM (69.2%) and DISE (84.6%).

Conclusion: This study shows a significant difference between FNMM and DISE in the identification of severe retrolingual collapse. Since the effectiveness of surgical interventions depends largely on the accurate preoperative identification of the site of obstruction, further scrutiny of each diagnostic endoscopic technique is warranted.

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Conflict of interest statement

Disclosures: Competing interests: None.

Figures

Figure 1
Figure 1
An example of the endoscopic disparity in apparent degree of severity of retrolingual collapse occurring during inspiration on FNMM (MM-A through MM-D) and DISE (DISE-A through DISE-D) same patient. MM-A and DISE-A = beginning inspiration; MM-D and DISE-D = end inspiration. DISE, drug-induced sleep endoscopy; FNMM, fiber-optic nasal endoscopy with Müller's maneuver.
Figure 2
Figure 2
Incidence of severe retrolingual collapse diagnosed via fiber-optic nasal endoscopy with Müller's maneuver (FNMM) or drug-induced sleep endoscopy (DISE) according to tongue size (Friedman tongue position). *Fisher's exact test.
Figure 3
Figure 3
Incidence of severe retrolingual collapse diagnosed via fiber-optic nasal endoscopy with Müller's maneuver (FNMM) or drug-induced sleep endoscopy (DISE) according to tonsillar grade. *Fisher's exact test.
See this image and copyright information in PMC

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