Endoscopic Upper Airway Evaluation in Obstructive Sleep Apnea: Mueller's Maneuver Versus Simulation of Snoring

Overview

Journal Sleep Breath

Publisher Springer

Date 2014 Nov 6

PMID 25369788

Citations 2

Authors

Hong Huo

Wuyi Li

Xu Tian

Chunxiao Xu

Jian Wang

Dahai Yang

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aimed to compare fiberoptic nasopharyngoscopy during Mueller's maneuver (FNMM) with fiberoptic nasopharyngoscopy with simulation of snoring (FNSS) for upper airway (UA) assessment in patients with obstructive sleep apnea and hypopnea syndrome. We also investigated the relationship between daytime endoscopic examinations and nocturnal pressure measurements.

Methods: We conducted a prospective, case-series study at Peking Union Medical College Hospital. All patients were evaluated by daytime FNMM and FNSS. The retropalatal and retroglossal regions were continuously video recorded during quiet breathing, FNMM, and FNSS. We calculated the narrowing rate and determined the level of obstruction and pattern of collapse (lateral, anterior-posterior, or concentric). Patients also underwent nocturnal pressure measurements to identify obstruction sites.

Results: Ninety-two patients were enrolled. FNMM and FNSS detected retropalatal obstruction in every case. Fifty-six and 38 patients had retroglossal obstruction detected by FNMM and FNSS, respectively. There was diagnostic agreement between FNMM and FNSS in 72 patients when diagnosing retroglossal obstruction, but the patterns of collapse were different using each technique. Pressure measurements showed that lower apnea and hypopnea index (AHI) and the proportion of lower AHI were significantly lower in the isolated retropalatal obstruction group than in the combined obstruction group diagnosed with either FNMM or FNSS (p < 0.01).

Conclusions: Daytime FNMM and FNSS are reliable for evaluating the level of obstruction and pattern of UA collapse, and correlate with sleep study findings. FNSS may provide some different information regarding patterns of collapse and retroglossal obstruction from FNMM. Both techniques are helpful for determining surgical strategies.

Citing Articles

Role of transpalatal advancement pharyngoplasty in management of lateral pharyngeal wall collapse in OSA.

ElSobki A, Moneir W, Abdelbadie Salem M, Elkahwagi M Braz J Otorhinolaryngol. 2021; 88 Suppl 1:S82-S90.

PMID: 33994340 PMC: 9734267. DOI: 10.1016/j.bjorl.2021.04.009.

Drug-induced sleep endoscopy and simulated snoring in patients with sleep-disordered breathing: agreement of anatomic changes in the upper airway.

Herzog M, Kellner P, Plossl S, Glien A, Rohrmeier C, Kuhnel T Eur Arch Otorhinolaryngol. 2015; 272(9):2541-50.

PMID: 25716772 DOI: 10.1007/s00405-015-3559-z.

References

De Vito A, Carrasco Llatas M, Vanni A, Bosi M, Braghiroli A, Campanini A . European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath. 2014; 18(3):453-65. DOI: 10.1007/s11325-014-0989-6. View

Safiruddin F, Vanderveken O, de Vries N, Maurer J, Lee K, Ni Q . Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions. Eur Respir J. 2014; 45(1):129-38. DOI: 10.1183/09031936.00059414. View

Bonora M, St John W, Bledsoe T . Differential elevation by protriptyline and depression by diazepam of upper airway respiratory motor activity. Am Rev Respir Dis. 1985; 131(1):41-5. DOI: 10.1164/arrd.1985.131.1.41. View

Croft C, Pringle M . Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci. 1991; 16(5):504-9. DOI: 10.1111/j.1365-2273.1991.tb01050.x. View

Pevernagie D, Aarts R, de Meyer M . The acoustics of snoring. Sleep Med Rev. 2009; 14(2):131-44. DOI: 10.1016/j.smrv.2009.06.002. View

Vanderveken O, Maurer J, Hohenhorst W, Hamans E, Lin H, Vroegop A . Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med. 2013; 9(5):433-8. PMC: 3629316. DOI: 10.5664/jcsm.2658. View

Singh A, Al-Reefy H, Hewitt R, Kotecha B . Evaluation of ApneaGraph in the diagnosis of sleep-related breathing disorders. Eur Arch Otorhinolaryngol. 2008; 265(12):1489-94. DOI: 10.1007/s00405-008-0685-x. View

Eichler C, Sommer J, Stuck B, Hormann K, Maurer J . Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea?. Sleep Breath. 2012; 17(1):63-8. DOI: 10.1007/s11325-012-0647-9. View

Strollo Jr P, Soose R, Maurer J, de Vries N, Cornelius J, Froymovich O . Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014; 370(2):139-49. DOI: 10.1056/NEJMoa1308659. View

10.

Tvinnereim M, Mitic S, Hansen R . Plasma radiofrequency preceded by pressure recording enhances success for treating sleep-related breathing disorders. Laryngoscope. 2007; 117(4):731-6. DOI: 10.1097/MLG.0b013e31803250f0. View

11.

Osnes T, Rollheim J, Hartmann E . Effect of UPPP with respect to site of pharyngeal obstruction in sleep apnoea: follow-up at 18 months by overnight recording of airway pressure and flow. Clin Otolaryngol Allied Sci. 2002; 27(1):38-43. DOI: 10.1046/j.0307-7772.2001.00520.x. View

12.

Ravesloot M, de Vries N, Stuck B . Treatment adherence should be taken into account when reporting treatment outcomes in obstructive sleep apnea. Laryngoscope. 2013; 124(1):344-5. DOI: 10.1002/lary.24302. View

13.

Abdullah B, Rajet K, Abd Hamid S, Wan Mohammad W . A videoendoscopic evaluation of the upper airway in South East Asian adults with obstructive sleep apnea. Sleep Breath. 2010; 15(4):747-54. DOI: 10.1007/s11325-010-0431-7. View

14.

Vroegop A, Vanderveken O, Boudewyns A, Scholman J, Saldien V, Wouters K . Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope. 2013; 124(3):797-802. DOI: 10.1002/lary.24479. View

15.

Hudgel D . Variable site of airway narrowing among obstructive sleep apnea patients. J Appl Physiol (1985). 1986; 61(4):1403-9. DOI: 10.1152/jappl.1986.61.4.1403. View

16.

Ravesloot M, de Vries N . One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope. 2011; 121(12):2710-6. DOI: 10.1002/lary.22369. View

17.

Won T, Kim S, Lee W, Han D, Kim D, Kim J . Acoustic characteristics of snoring according to obstruction site determined by sleep videofluoroscopy. Acta Otolaryngol. 2012; 132 Suppl 1:S13-20. DOI: 10.3109/00016489.2012.660733. View

18.

Sadaoka T, Kakitsuba N, Fujiwara Y, Kanai R, Takahashi H . The value of sleep nasendoscopy in the evaluation of patients with suspected sleep-related breathing disorders. Clin Otolaryngol Allied Sci. 1996; 21(6):485-9. DOI: 10.1111/j.1365-2273.1996.tb01095.x. View

19.

Borowiecki B, Sassin J . Surgical treatment of sleep apnea. Arch Otolaryngol. 1983; 109(8):508-12. DOI: 10.1001/archotol.1983.00800220014004. View

20.

Borowiecki B, Pollak C, Weitzman E, Rakoff S, Imperato J . Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleep-apnea syndrome. Laryngoscope. 1978; 88(8 Pt 1):1310-3. DOI: 10.1288/00005537-197808000-00012. View