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. 2022 Dec;42(6):554-559.
doi: 10.14639/0392-100X-N2143.

Role of functional and anatomic study in sleep endoscopy for treatment of OSA

Andrea Marzetti  1   2 , Caterina Tripodi  1 , Ingrid Raponi  2
Affiliations

Role of functional and anatomic study in sleep endoscopy for treatment of OSA

Andrea Marzetti et al. Acta Otorhinolaryngol Ital. 2022 Dec.

Abstract
in English, Italian

Objective: To describe a clear and intuitive way to analyse the anatomical meaning of images observed in Drug-induced Sleep Endoscopy (DISE) to fully understand the obstructive dynamics and therefore opt for a tailor-made pharyngeal surgical technique.

Methods: From January 2016 to December 2020, 298 patients who underwent DISE were selected according to inclusion criteria.

Results: The case series consisted of 204 males and 94 females with a mean age of 56 years. Body mass index ranged from 19 kg/m2 to 34 kg/m2 with a median of 26.5 kg/m2. Median Apnoea-Hypopnea Index (AHI) was 27 (range 5-62.3). The authors also observed four palate pharyngeal phenotypic patterns of collapse and clarify the morphology and role of the main muscles involved in upper airway collapse.

Conclusions: DISE is fundamental to determine the collapse site in patients affected by obstructive sleep apnoea syndrome. The velopharyngeal region is the most common site of obstruction and lateral pharyngeal wall collapse is the major determining factor. DISE can lead to a deeper understanding of the obstructive dynamic patterns and a more precise identification of the muscle bundles responsible for upper airway collapse.

Ruolo dello studio funzionale e anatomico durante la sleep endoscopy nella terapia delle OSAS.

Obiettivo: Descrivere in modo chiaro e intuitivo il significato anatomico delle immagini osservate durante la Sleep Endoscopy (DISE) per comprendere appieno la dinamica ostruttiva e per poter poi indirizzare la scelta terapeutica verso una chirurgia personalizzata.

Materiali e metodi: Da gennaio 2016 a dicembre 2020, 298 pazienti sottoposti a Sleep Endoscopy sono stati selezionati, sulla base di criteri di inclusione.

Risultati: I pazienti inseriti nello studio erano 204 maschi e 94 femmine con un’età media di 56 anni. L’indice di massa corporea variava da 19 kg/m2 a 34 kg/m2 con un valore mediano di 26,5 kg/m2. L’indice di apnea-ipopnea (AHI) medio era di 27 (range 5-62,3). Gli autori hanno anche osservato quattro modelli fenotipici di collasso del palato e chiariscono la morfologia e il ruolo dei principali muscoli coinvolti nel collasso dell’UA.

Conclusioni: La DISE è fondamentale per determinare il sito di collasso nei pazienti affetti dalla sindrome dell’apnea ostruttiva del sonno (OSA). La regione velofaringea è il sito più comune di ostruzione e il collasso laterale della parete faringea è il principale fattore determinante. La DISE può portare a una comprensione più profonda dei modelli dinamici ostruttivi e a un’identificazione più precisa dei fasci muscolari responsabili del collasso delle vie aeree superiori.

Keywords: OSA surgery; barbed sutures; drug induced sleep endoscopy; palatal surgery; palatopharyngeal muscles.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Muscles of the palatopharyngeal complex. (A) lateral view; (B) anterior view; (C) posterior view; (D) figure legend.
Figure 2.
Figure 2.
Vectorial classification of palatopharyngeal collapse patterns.
Figure 3.
Figure 3.
Secondary palate collapse. (A) no secondary collapse; (B) partial palatal collapse; (C) total palatal collapse (TPC); (D) TPC with palatal elevation.
Figure 4.
Figure 4.
How to achieve an eclectic approach to OSA surgery.
See this image and copyright information in PMC

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