LAUSR

Sleep endoscopy during natural sleep will be ideal, to evaluate the upper airway during episodes of obstructive sleep apnea, but quite difficult to achieve. Drug-induced sleep endoscopy is an alternative standard of care to document the level and severity of the collapse of the upper airway. It is especially of benefit for patients who are intolerant to positive airway pressure and is used as a part of a work-up for alternative therapy for treating sleep apnea. Using propofol infusion and a Bi-spectral index of 50-70, to monitor the depth of sedation, the upper airway collapse can be determined with sleep endoscopy, conducted initially without CPAP and then with a CPAP ranging from 10 cmH2O to 20 cm H2O in patients who failed PAP therapy. Drug-induced sleep endoscopy (DISE) was carried out in the bronchoscopy suite by the same Pulmonologist with an anesthesiologist to manage sedation using Propofol. Adequate depth of sedation was confirmed by the presence of snoring, and a BIS. The patient underwent the entire procedure while supine. The severity of obstructions followed the velum/oropharynx/tongue base/epiglottis and was recorded as patent/partial/complete. The obstruction pattern was classified into circumferential, anteroposterior, or lateral. Tongue base obstruction was identified when the tongue base pushed the epiglottis causing lumen obstruction. The DISE was conducted initially without CPAP followed by DISE with CPAP. Out of a total of 80 patients, upon application of the CPAP, 3 patients (4%) had patent velum and the base of the tongue. 3 (4%) with partial collapse of the velum and complete collapse of the base of the tongue. One (1%) had persistent anterior-posterior and lateral wall collapse of the velum, but the base of the tongue was patent. 68 (85%) had improved lateral wall collapse and obstruction of the velum improved from complete to partial anteroposterior collapse. Five patients (6%) continued to have persistent circumferential collapse of the velum. Drug-induced sleep endoscopy performed in combination with various pressures of CPAP allows real-time visualization of the impact of these pressures on the upper airway. It allows us to provide alternative treatment options sooner than later.