Guidance Value Of Drug-induced Sleep Endoscopy Of Surgery For OSAHS Using VOTE Classification System

Purpose and significanceBefore making surgery for patients with OSAHS,using DISE to find the sites of airway obstruction can increase the percentage of success.However,there is no consensus has been reached on a scoring and classification system on DISE.In recent years,foreign scholars put up a VOTE classification to describe the result of DISE,while not been mentioned interiorly.The purpose of the study is to compare the difference of the Sites of Airway Obstruction in Obstructive Sleep Apnea Hypopnea Syndrome patients between awake and sleep state by using the VOTE classification system.And compare the difference of the results between DISE and Friedman Stage.Then try to analyze the relation between the results of DISE and the outcome of Multilevel surgery.Materials and methods56 Obstructive Sleep Apnea Hypopnea Syndrome patients diagnosed by PSG underwent Friedman clinical stage,awake Muller's maneuver and Drug-induced sleep endoscopy(DISE).There were 40 patients been video the result.Then compare the observation sites of these two maneuvers.All of the findings were described using the VOTE(velum,oropharynx,tongue base,epiglottis)classification system which include the following features:level,degree and configuration of obstruction.Associations were analyzed between different degree of obstruction,BMI,AHI,Minimal Sa02 and Average Sa02.And compare the difference of the results between DISE and Friedman Stage.Then analyze the relation between the results of DISE and the short and long outcome of Multilevel surgery.ResultsThe first chapter:In DISE,airway closure of 95%cases related to velum occurred collapse in concentric configuration,and 90%cases showed completely obstructive.We found that 60%complete oropharyngeal lateral wall collapse and 17.5%complete tongue base collapse.Our patients had 52.5%complete velum collapse and 30%complete oropharyngeal lateral wall collapse' in awake Muller's maneuver.There was a significant difference in the VOTE scores between DISE and awake Muller's maneuver,and the VOTE scores of DISE were higher in all levels(P<0.05).No association was found between degree of obstruction,AHI,BMI,Minimal Sa02 and Average Sa02 in Muller's maneuver(P>0.05).Complete velum collapse was just significantly associated with AHI and Minimal Sa02 in DISE(P<0.05).The second chapter:In the comparison of DISE and Friedman clinical stage,we found that there was a significant difference between the collapse rate of different tonsil group in the oropharyngeal lateral wall level(P<0.05).And no association was found between the collapse rate of different Friedman Clinical stage groups(P>0.05),but a significant difference between the Friedman tongue site groups in the tongue base level(P<0.05).The third chapter:By analyzing the outcome of these patients,it showed that,in the oropharyngeal lateral wall level,there was a significant difference between the collapse rate of different short outcome group(P<0.05).No association was found between the collapse rate of different long outcome group(P>0.05).Conclusion1.The VOTE scores of DISE were higher than awake Muller's maneuver,reflected by more obstructive levels and severe degree.The difference between different degree of obstruction,BMI,AHI,Minimal Sa02 and Average Sa02 was not significant.2.Large tonsil indicates the obstruction of the oropharyngeal lateral wall level.The evaluation of the tongue base level by DISE is better than Friedman clinical stage and Friedman tongue position stage.The high tongue position doesn't mean a high collapse rate in tongue base level.3.By using the vote classification system,the patients with obstruction in velum and oropharyngeal lateral wall level will get a better short outcome through Multilevel surgery.The Relation between the results of the DISE and the long outcome of the Multilevel surgery still need a lot to do.