The role of drug-induced sleep endoscopy for positive airway pressure titration – initial results

Abstract

Aim: The aim of the work was to monitor the eff ect of positive airway pressure (PAP) on the particular sites of obstruction during the drug-induced sleep endoscopy to evaluate at which pressure the obstruction disappears/worsens and to clarify possible reasons for PAP intolerance. Materials and Methods: In the period from 6/2018 to 12/2020, a PAP test was performed during the drug-induced sleep endoscopy in 20 patients with obstructive sleep apnea without previous therapy. During the examination, sites of obstruction in the upper respiratory tract were identifi ed. It was evaluated how the diff erent pressure set during PAP ventilation refl ects on the behaviour of the upper respiratory tract, and on its expansion or collapse leading to its obstruction. Monitoring was started at a pressure of 6 hPa, and gradually the pressure was increased stepwise by 2 hPa in the range from 6 to 18 hPa. Each pressure was applied for a minimum of 20 s. The fi ndings were evaluated using the VOTE classifi cation according to Kezirian and compared with each other. Results: The best eff ect of PAP was observed in the case of anteroposterior obstruction in the soft palate area, where the average opening pressure was 11.2 hPa. For laterolateral oropharyngeal obstruction, the average opening pressure was 12 hPa. PAP had no eff ect in 8/20 patients, 6 times due to concentric or laterolateral obstruction of the soft palate, and twice due to the collapse of the epiglottis. In the collapsing epiglottis, PAP ventilation does not relax the airways, because with increasing PAP pressure, the obstruction and suction of the epiglottis on the posterior wall of the pharynx worsens. Conclusion: Drug-induced sleep endoscopy of the upper airways with PAP is a simple and easy-to-perform examination which can reduce PAP intolerance (e.g., in the event of an epiglottis collapse) and thus optimize the treatment. We assume better compliance of the pressure device in patients who are indicated for this treatment. Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers. M. Masárová1,2, J. Seko1, M. Plášek1,2, M. Formánek1,2, O. Jor3, V. Novák4, P. Komínek1,2, P. Matoušek1,2 1 Klinika otorinolaryngologie a chirurgie hlavy a krku LF OU a FN Ostrava 2 Katedra kraniofaciálních oborů, LF OU, Ostrava 3 Klinika anesteziologie, resuscitace a intenzivní medicíny FN Ostrava 4 Centrum pro poruchy spánku a bdění – spánková laboratoř, Oddělení dětské neurologie,