Obstructive Sleep Apnea
Conditions
Keywords
sleep endoscopy, sedation
Brief summary
Drug induced sleep endoscopy (DISE) has been performed worldwide since 1991 to determine the site and configuration of upper airway obstruction in patients with obstructive sleep apnea (OSA). However, there are no studies comparing DISE to sleep endoscopy during natural sleep. Objectives: To compare DISE to natural sleep endoscopy in OSA patients referred for surgical treatment. Methods: OSA patients referred to surgical treatment (lateral pharyngoplasty) will be enrolled in this study. Natural sleep endoscopy will be performed at the sleep lab during the night. Propofol induced sleep will be performed at the operating room before surgery. The VOTE (velum, oropharyngeal lateral walls, tongue base and epiglottis) classification will be used to compare site and configuration of collapse between studies. Peak inspiratory flow will also be compared between studies.
Detailed description
Drug induced sleep endoscopy (DISE) has been performed worldwide since 1991 to determine the site and configuration of upper airway obstruction in patients with obstructive sleep apnea. However, there are no studies comparing DISE to sleep endoscopy during natural sleep. Objective: to compare natural sleep endoscopy to drug induced sleep with propofol. The study population will include 28 patients who are candidates to surgical treatment. Methods Detailed clinical history and physical examination will be performed before natural sleep endoscopy. A 2-hour fast will be required. During both natural sleep and propofol-induced sleep, pharyngeal pressure will be measured using a pressure-tipped catheter (model TC-500XG; Millar).The nasopharynx will be numbed with xylocaine (10%) and oxymetazoline (0.05%), the catheter will be passed through a nasal mask into one nostril, and placed at the tongue base as confirmed by visual inspection of the oropharynx.A 2.8mm pediatric bronchoscope (Olympus) will be passed through the mask and into the other nostril. A nasal mask will be fitted and a heated pneumotachograph with differential pressure transducer connected to the mask will quantify airflow. The endoscope will be located at velopharynx, lateral wall of the pharynx and 2 cm above tongue and epiglottis.The VOTE Endoscopic Classification will be used to describe site and configuration of pharyngeal collapse in each study. The study will be scored by two experienced investigators, blind to the patient identification and type of study (natural sleep or drug-induced). Propofol-induced sleep will be performed at the operating room before surgery.
Interventions
OTHERSleep endoscopy during propofol induced sleep
It will be performed a sleep endoscopy during drug induced sleep endoscopy
Sponsors
Pedro Rodrigues Genta
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* BMI less than 35kg/m2 * Apnea-hypopnea index \> 5 events/hour of sleep * Clinical indication of surgical treatment for sleep apnea
Exclusion criteria
* Severe or decompensated cardiac or respiratory diseases * Previous pharyngeal surgery * Tonsils grade III or IV * Other sleep disturbance (parasomnias, primary insomnia, narcolepsy) * Sedative medication use (opioids, benzodiazepines and muscle relaxants) * Uncontrolled diabetes or hyperthyroidism
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The VOTE Endoscopic Classification | Immediately, during the procedure | Comparison of site and configuration of endoscopy findings between the natural and drug-induced sleep endoscopy. The VOTE Endoscopic Classification describes the patterns and the degree of obstruction during sleep endoscopy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Peak inspiratory flow | Immediately, during the procedure | Peak inspiratory flow measured during both natural and drug-induced sleep endoscopy |
Countries
Brazil
Outcome results
None listed