Clin Exp Otorhinolaryngol.  2021 May;14(2):149-158. 10.21053/ceo.2020.01704.

The Emerging Role of Drug-Induced Sleep Endoscopy in the Management of Obstructive Sleep Apnea

• Cheong CS
• Loke W
• Thong MKT
• Toh ST
• Lee CH

• KMID: 2515427
• DOI: http://doi.org/10.21053/ceo.2020.01704

Abstract

Obstructive sleep apnea is a prevalent sleep disorder characterized by partial or complete obstruction of the upper airway. Continuous positive airway pressure is the first-line therapy for most patients, but adherence is often poor. Alternative treatment options such as mandibular advancement devices, positional therapy, and surgical interventions including upper airway stimulation target different levels and patterns of obstruction with varying degrees of success. Drug-induced sleep endoscopy enables the visualization of upper airway obstruction under conditions mimicking sleep. In the era of precision medicine, this additional information may facilitate better decision-making when prescribing alternative treatment modalities, with the hope of achieving better adherence and/or success rates. This review discusses the current knowledge and evidence on the role of drug-induced sleep endoscopy in the non-positive airway pressure management of obstructive sleep apnea.

Keyword

Surgery; Mandibular Advancement Device; Obstructive Sleep Apnea; Endoscopy

Figure

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  Fig. 1. The narrow retropalatal and retrolingual spaces seen during drug-induced sleep endoscopy (A) expand when a jaw thrust maneuver is performed (B).

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  Fig. 2. The tongue base collapse seen in supine position (A) during drug-induced sleep endoscopy improves with head turning (B). The effect of palatal coupling is also visible in (B).

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  Fig. 3. (A) Endoscopic view of the upper airway at rest. (B) The lateral oropharyngeal walls collapsed partially during the Müller maneuver. (C) However, complete collapse was seen during drug-induced sleep endoscopy.

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  Fig. 4. Rhythmic complete anteroposterior collapse of the epiglottis was seen during drug-induced sleep endoscopy. This did not occur during the clinical examination while the patient was awake, even during the Müller maneuver.

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