Mariane S Yui1, Quedayr Tominaga1, Bruno C P Lopes2, Alan L Eckeli3, Leila A de Almeida3, Fabio A W Rabelo4, Daniel S Küpper1, Fabiana C P Valera5. 1. ENT Division, Clinics Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes, 3900-12o andar, CEP 14049-900, Ribeirão Preto, São Paulo, Brazil. 2. Anesthesiology Division, Clinics Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil. 3. Neurosciences Division, Clinics Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil. 4. Hospital Samaritano São Paulo, São Paulo, Brazil. 5. ENT Division, Clinics Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes, 3900-12o andar, CEP 14049-900, Ribeirão Preto, São Paulo, Brazil. facpvalera@fmrp.usp.br.
Abstract
PURPOSE: Drug-induced sleep endoscopy (DISE) has been poorly explored as an examination to assess positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA). The present study aimed to identify by DISE possible characteristics related to low compliance with PAP therapy due to respiratory complaints. METHODS: Patients using PAP for OSA underwent DISE in two conditions: (1) baseline (without PAP) and (2) PAP (with the same mask and airway pressure used at home). We compared patients reporting low compliance to PAP due to respiratory complaints to those well-adapted to therapy. VOTE classification (assessment of velopharynx, oropharynx, tongue base, and epiglottis) and TOTAL VOTE score (the sum of VOTE scores at each anatomical site) were assessed. ROC curve analyzed the accuracy of TOTAL VOTE to predict low compliance due to persistent pharyngeal obstruction in both conditions. RESULTS: Of 19 patients enrolled, all presented multilevel pharyngeal obstruction at baseline condition, with no difference between groups at this study point. When PAP was added, the median VOTE value was higher in the epiglottis (P value=0.02) and tended to be higher at the velum and tongue base in the poorly adapted group; TOTAL VOTE score was also significantly increased in patients with low compliance (P value<0.001). ROC curve demonstrated that patients with TOTAL VOTE scored 2.5 or more during DISE with PAP presented a 4.6-fold higher risk for low compliance with PAP therapy due to pharyngeal obstruction (AUC: 0.88±0.07; P value<0.01; sensitivity: 77%; specificity: 83%). CONCLUSIONS: Adding PAP during a DISE examination may help to predict persistent pharyngeal obstruction during PAP therapy.
PURPOSE: Drug-induced sleep endoscopy (DISE) has been poorly explored as an examination to assess positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA). The present study aimed to identify by DISE possible characteristics related to low compliance with PAP therapy due to respiratory complaints. METHODS: Patients using PAP for OSA underwent DISE in two conditions: (1) baseline (without PAP) and (2) PAP (with the same mask and airway pressure used at home). We compared patients reporting low compliance to PAP due to respiratory complaints to those well-adapted to therapy. VOTE classification (assessment of velopharynx, oropharynx, tongue base, and epiglottis) and TOTAL VOTE score (the sum of VOTE scores at each anatomical site) were assessed. ROC curve analyzed the accuracy of TOTAL VOTE to predict low compliance due to persistent pharyngeal obstruction in both conditions. RESULTS: Of 19 patients enrolled, all presented multilevel pharyngeal obstruction at baseline condition, with no difference between groups at this study point. When PAP was added, the median VOTE value was higher in the epiglottis (P value=0.02) and tended to be higher at the velum and tongue base in the poorly adapted group; TOTAL VOTE score was also significantly increased in patients with low compliance (P value<0.001). ROC curve demonstrated that patients with TOTAL VOTE scored 2.5 or more during DISE with PAP presented a 4.6-fold higher risk for low compliance with PAP therapy due to pharyngeal obstruction (AUC: 0.88±0.07; P value<0.01; sensitivity: 77%; specificity: 83%). CONCLUSIONS: Adding PAP during a DISE examination may help to predict persistent pharyngeal obstruction during PAP therapy.
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Authors: Olivier M Vanderveken; Joachim T Maurer; Winfried Hohenhorst; Evert Hamans; Ho-Sheng Lin; Anneclaire V Vroegop; Clemens Anders; Nico de Vries; Paul H Van de Heyning Journal: J Clin Sleep Med Date: 2013-05-15 Impact factor: 4.062
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Authors: Anneclaire V M T Vroegop; Olivier M Vanderveken; Marijke Dieltjens; Kristien Wouters; Vera Saldien; Marc J Braem; Paul H Van de Heyning Journal: J Sleep Res Date: 2012-12-04 Impact factor: 3.981
Authors: Clete A Kushida; Michael R Littner; Max Hirshkowitz; Timothy I Morgenthaler; Cathy A Alessi; Dennis Bailey; Brian Boehlecke; Terry M Brown; Jack Coleman; Leah Friedman; Sheldon Kapen; Vishesh K Kapur; Milton Kramer; Teofilo Lee-Chiong; Judith Owens; Jeffrey P Pancer; Todd J Swick; Merrill S Wise Journal: Sleep Date: 2006-03 Impact factor: 5.849
Authors: Jean Christian Borel; Renaud Tamisier; Sonia Dias-Domingos; Marc Sapene; Francis Martin; Bruno Stach; Yves Grillet; Jean François Muir; Patrick Levy; Frederic Series; Jean-Louis Pepin Journal: PLoS One Date: 2013-05-15 Impact factor: 3.240
Authors: Danielle L C Queiroz; Mariane S Yui; Andréa A Braga; Mariana L Coelho; Daniel S Küpper; Heidi H Sander; Leila A Almeida; Regina M F Fernandes; Alan L Eckeli; Fabiana Cardoso Pereira Valera Journal: Braz J Otorhinolaryngol Date: 2014-04