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. 2013 Aug;33(4):261-6.

Identification of obstructive sites and patterns in obstructive sleep apnoea syndrome by sleep endoscopy in 614 patients

F Salamanca  1 , F Costantini, A Bianchi, T Amaina, E Colombo, F Zibordi
Affiliations

Identification of obstructive sites and patterns in obstructive sleep apnoea syndrome by sleep endoscopy in 614 patients

F Salamanca et al. Acta Otorhinolaryngol Ital. 2013 Aug.

Abstract
in English, Italian

The aim of this study was to analyze and report sites and patterns of obstruction observed during sleep endoscopy in a large group of patients and suggest consequent therapeutic prescriptions. 614 consecutive patients who approached the Centre for Diagnosis and Treatment of Respiratory Sleep Disorders underwent sleep endoscopy. We used propofol to induce sleep, monitoring the value of bispectral index to evaluate the depth of sedation. For each patient, we recorded obstruction sites,obstruction patterns and the effects of the mandibular pull-up manoeuvre on both obstruction and snoring. We ascertained that, in almost all patients, the noise of snoring was generated at the oropharyngeal level. The obstruction at the oropharyngeal level, either in isolation or in combination with other structures, is far more common. The mandibular pull-up manoeuvre was effective in reducing or resolving the obstruction in a large number of patients, even though their AHI values were high. For those patients having an AHI over 15, we point out the various therapeutic indications gained from the sleep endoscopy examinations. Drug-induced (propofol) sleep endoscopy can be considered be a safe procedure, easily practicable, valid and reliable; we therefore consider it a fundamental clinical investigation that can be essential when choosing treatment.

Abbiamo sottoposto a Sleep Endoscopy 614 pazienti consecutivi che si sono rivolti al nostro Centro per la Diagnosi e Cura dei Disturbi Repiratori del Sonno, allo scopo di rilevare e riportare i siti ed i pattern di ostruzione osservati nel corso di questo esame in un ampio gruppo di pazienti e di riferire le relative prescrizioni terapeutiche. È stato utilizzato il propofol per indurre il sonno, controllando il valore di BIS (Bispectral Index) per valutare la profondità della sedazione; per ogni paziente sono stati riportati i siti ed i pattern di ostruzione, oltre ai risultati della manovra di avanzamento mandibolare, sia sull'ostruzione che sul russamento. Abbiamo rilevato che in quasi tutti i pazienti il rumore del russamento era generato a livello orofaringeo. Anche l'ostruzione a livello orofaringeo, sia isolata che associata ad altre strutture è risultata di gran lunga la più comune. La manovra di avanzamento mandibolare è risultata efficace e quindi in grado di ridurre o risolvere l'ostruzione in un gran numero di pazienti, anche tra quelli con valori di AHI elevati. Per i soggetti con indice di AHI superiore a 15 vengono anche riportate le varie indicazioni terapeutiche ricavate dall'esame di Sleep Endoscopy. La Sleep Endoscopy eseguita con propofol si è dimostrata una procedura sicura, di facile realizzazione, in grado di fornire risultati validi ed affidabili; nella nostra opinione al momento si tratta di un elemento essenziale nella scelta del trattamento.

Keywords: Mandibular pull-up manoeuvre; Obstructive sleep apnoea syndrome; Oral device; Sleep endoscopy.

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