Study On Evaluation Strategy Of Upper Airway Obstruction Plane On OSAHS By Drug-induced Sleep Endoscopy

Background and PurposeOSAHS(Obstructive Sleep Apnea Hypopnea Syndrome,OSAHS)patients have poor compliance with long-term wear of the ventilator.making their treatment effective.Surgical treatment has become another option for many OSAHS patients.Preoperative assessment of upper airway obstruetion plaine by drug-inducced sleep endoscopy(DISE)can effeetivehy assess upper airway collapse and significantly improve the cefficiency of upper airway multi-planar sungery.However,there are many evaluation methods tor DISE technology,and different researchers use different evaluation methods.Even if the same evaluation system cannot be objectively measured,the evaluation of the results of DISE will be partly subjective,and different scorers may draw inconsistent conclusions,thereby reducing the success rate of surgery.In addition,a large number of studies suggest that each obstruction plane in OSAHS patients is not isolated,and the determination of primary collapse sites is particularly important for an OSAHS patient undergoing surgery.The DISE examination can not observe the entire upper airway at the same time,and at the same time can not identify the primary collapse site.It is still debatable whether the airway collapse on the multi-plane observed by DISE requires surgery.Among the many exvaluation methods of DISE.VOTE classification,proposced by Kezirian et al.in 2011,which is capable of semi-quantitative description of upper airway obstruction is most Ccommonly used,and its assessment involves upper airvway obstruction plane,obstruction configuration and obstruction degree.This study intends to use the VOTE classification to perform a subjective consistency test on the results of the DISE assessment and to explore the factors that influence the difference in scores between different scorers.In order to improve the accuracy of assessing the upper airway plane collapse and improve the efficiency of upper airxway multiplanar Ssurgery.Further,the nasopharyngeal tube was used to investigate the chalnges of the other plane obstruction after the relief of the pharyingeal plane obstruction,Identify the primary ccollapse of the uppcer airway plane and reduce unnecessary surgical planes.At the same time,the relationship between the different obstruction planes of the upper airway was analyzed,and the short-term surgical effect was evaluated,Verify the surgical guidance of DISE combined with nasopharyngeal tube..MethodPart ?:sixty-four OSAHS patients who were admitted to the otolaryngology department of nanfang hospital of southern medical university from December 2014 to July 2018 for surgical treatment were included.Two prospective surgeons used a VOTE classification to double-bliind assess the preoperative DISE test vicdeo,Calculate the kappa value betwceen the two raters ancd use Fisher's exact test or chi-square test to fiurtlher explore the factors af-fecting the consistency of'the score.Part?:25 OSAHS patients who were admitted for surgical tr-eatment from May 2018 to December 2018 were included..Patients underwent routine DISE assessment of upper airway obstruction,followed by placement of a nasopharyngeal tube to visualize the upper airway obstruction plane change,and the surgical plan was determined based on the second DISE test result.Using Fisher's exact test or chi-square test,The statistical analysis of the change of different collapse planes is carried out.and the upper airway collapses are futlher subdividced into two groups with changes and no changes,and other factors affecting the plane change are statistical ainalysed.Finally,combined witlh the results of sleep monitoring 1 week after suryery.the short-term surgery results were anialyzedResultPart ?:the consistency test of the evaluation results of the two scorers.In the assessment of whether the upper airway plane collapsed,the two scorers had a moderate assessment consistency in the epiglottis plane and the tongue base(0.41<kappa value<0.60),and a general assessment consistency in both the pharyngeal plane and the oropharynx plane(0.21<kappa value<0.40).In the assessment of the collapse configuration of different planes.both the pharyngeal plane and the epiglottis plane had good evaluation consistency(0.61<kappa value<0.80).Because there is only one type of collapse configuration of the oropharynx plane and the tongue base,no statistical analysis is needed.In the evaluation of collapse degree,there was general evaluation consistency in the pharyngeal plane,oropharynx plane and tongue base plane(0.21<kappa valuc<0.40),and the consistency in the assessment of the epiglottis plane was slight(0.01<kappa value<0.20)The collapse of the four planes was divided into two groups,which were consistent and inconsistent,to explore the factors that led to the cdifferences between the scorers.The size of the tonsils has an effect on the assessment of the presence or absence of oropharyngeal plane collapse(P<0.01).Among the scorers,the consistency of each plane was evaluated and gender,age.AHL.BMI.minimum bloocd oxygen,mean blood oxygen,Frdidman tongue-back index.Frcicdman comprehensive grade,tongue lymphoid follicle,and epiglottis morphology were not obvious.Statistical significancePart ?:After the obstruction of the pharyngeal plaine was relieved,the oropharyngeal plane and the collapse of the epiglottis plane were all relieved(P<0.05).There was a certain remission trencd in the ton<gue base,but the change was not statistically-significant(P>0.05).Further analysis of tother possible factors that caused changes in the collapse plane after the relief of the lpharyngeal plane was observed.In patients with higher tongue base grading,the possibility of tongue base plane collapse was more likelxy to be rcsolved(P<0.(05).In the oropharynx plane and the epiglcottis plane,no other factors that may affeet the change of the collapse plane were founcd.Paticents with a nasopharyngeal tube combined with DISE technology to develop a surgical plan have a short-term response rate of 60%.oThere is little difference in the short-term efficiencv of 64/%of-the conventional multi-planar surgery in the previous study.Conclusion1.surgeons with comparable clinical experience have a good evaluation consistency of the collapse configuration of the pharyngeal and epiglottis planes when performing the VOTE score of DISE,and have a moderate assessment consistency in the collapse of the tongue base and epiglottis;for the velum and oropharynx,There is a general assessment consistency of the degree of collapse and its collapse,and the assessment of the degree of collapse of'the tongue base is generally consistent,while the assessment of the cdegree of collapse of the ep.iglottis is only slightly consistent.Among them.the assessmcent of whether the oropharynx plane collapses is affected by the size of the tonsils.For patients with small tonsils,the assessment of oropharyngeal plane collapse should be cautious.2.After placement of the nasopharyngeal tube.The collapse of oropharyngeal plane and epiglottis plane was improved in patients with velum plane obstruction.in the tongue base,there was only a tendency to improve the collapse,but not statistically sicgnificant.Hoxwevcr,a Ssubgroup analysis found that patients with higher grade of tongue base had statistically significant relief in the collapse of the plane.DISE combinced with a nasopharyngeal tube can identify obstructive planes that do require surgical trceatment and reduce unnecessary surgical damage.