The Role Of Drug-induced Sleep Endoscopy:Predicting And Guilding Upper Airway Surgery For Adult OSA Patients

PurposePrior to upper airway surgery,drug-induced sleep endoscopy(DISE)is routinely used to evaluate the sites and degree of airway obstruction of OSA patients.However,few studies concentrate on the relationships between the findings of DISE and the final surgical effects.Therefore,the study intended to evaluate the ability ofdruginduced sleep endoscopy to predict the final effect of upper airway surgery and guide treatment decision making.MethodsA retrospective analysis was conducted on 85 adult patients with OSA(50 men with mean apnea-hypopnea index [AHI] 30±15 events/hour)in the department of Otorhinolaryngology of Qianfoshan hospital from 2015 to 2017.Friedman tonsil classification and druginduced sleep endoscopy were performed for each patient with all videos recorded,followed by general anesthesia,tonsillectomy oruvulopalatopharyngoplasty(UPPP)would be performed.The VOTE classification was used to analyze the video and describe the sites,degree and configuration of the upper airway obstruction.After 2 years follow-up,each patient would receive PSG to evaluate the effects of upper airway surgery.Statistical analysis was performed using SPSS22.0,categorical measures were compared by chisquare test,and all ordinal data wereanalyzed by Kruskal-Wallis H test.The results were considered statistically significant for p values < 0.05,by which we can figure out the relationships between theresults of DISE and the effects of upper airway surgery.Success was defined as a postoperative value of the AHI less than 20 events/h along with more than50% postoperative reduction of AHI(responders)ResultsOf the 85 patients evaluated,48(53%)were responders.Differences between success rates after upper airway surgery between responders and nonresponders in Friedman tonsil grading(P = 0.000)and findings under DISE were statistically significant(P< 0.05),according to the VOTE classification,the obstruction of velum(P = 0.000),oropharyngeal lateral walls(P = 0.001),tongue base(P = 0.000)and epiglottis(P = 0.044).And the collapse of oropharyngeal lateral walls(R = 0.356),tongue base(R = 0.630)and the epigl-ottis(R = 0.272)show negative correlation with the success rate of surgery,while the degree of tonsillar hypertrophy is positively correlated with the success rate(R = 0.765).Complete circumferential collapseat velum and complete anterior-posterior collapse at tongue base occurred at higher frequencies in nonresponders.In contrast,the presence of grade 3-4tonsillar hypertrophy and anterior-posterior mild/partial collapse at velum were positively associated with responders.ConclusionsOur results suggest that DISE may help predict the final outcome of tonsillectomy,UPPP in adult OSA patients.The use of DISE shows potential to guide treatment decisions for individual patients with OSA.Complete circumferential collapse at velum and complete anterior-posterior collapse at tongue base occurred at higher frequencies can predict high failure rate.In contrast,the presence of grade 3-4 tonsillar hypertrophy and anteriorposterior mild/partial collapse at velum were recommended to accept the upper airway surgery.