Research on upper airway compliance in OSAHS patients with MSMSMS / 中国基层医药

Objective To investigate the application of fiberoscope on upper airway compliance in OSAHS patients with MSMSMS. Methods From May 2014 to December 2015,93 patients with OSAHS in Jinhua Central Hospital were detected by MSMSMS[including 32 mild cases (MI),31 moderate cases (MO),and 30 severe cases (SE)] underwent electronic nasopharyngeal examination combined with the Muller test. The course of 93 OSAHS patients were recorded,including body mass index (BMI),sleep apnea index (AHI),mean oxygen saturation. The degree of collapse in the patients' soft palate area,tongue,epiglottis after area were calculated by the software. The results were analyzed by SPSS15. 0 statistical software. Results The disease courses between the mild group and moderate group [(4. 93 ± 2. 91)years,(8. 91 ± 4. 87)years],as well as between the moderate group and severe group [(4. 93 ± 2. 91)years,(9. 27 ± 4. 75) years],had statistically significant differences (t = - 3. 97,P = 0. 001;t =- 4. 33,P < 0. 001). The pairwise intergroup comparison of AHI among the three groups[(7. 75 ± 2. 49) times, (23. 24 ± 3. 74)times,(53. 27 ± 13. 59)times] showed statistically significant differences(t = 15. 49,P = 0. 000;t =- 45. 52,P = 0. 000;t = - 30. 02,P = 0. 000). The differences of MSaO2 between the mild group and severe group [(94. 25 ± 1. 11)％ vs. (94. 45 ± 0. 72)％ ],as well as between the moderate group and severe group[(94. 45 ± 0. 721)％ vs. (91. 40 ± 3. 17)％ ] had statistically significant differences ( t = 2. 85,P = 0. 000;t = 3. 05,P =0. 000). In the SE,there was a positive correlation with mean oxygen saturation (r = 0. 45,P = 0. 007). The collapse of soft palate area among the three groups had statistically significant differences (t = 3. 74,P = 0. 005;t = - 8. 39, P = 0. 000;t = - 4. 65,P = 0. 001). The collapse of posterior tongue area between the moderate group and mild group [(72. 65 ± 1. 56)％ vs. (66. 69 ± 8. 64)％ ],the mild group and severe group[(66. 69 ± 8. 64)％ vs. (74. 33 ± 10. 96)％ ] had statistically significant differences (t = 5. 96,P = 0. 008;t = - 7. 65,P = 0. 001). There was no statistically significant difference between the moderate group and severe group in the collapse of posterior tongue area (P > 0. 05). There were statistically significant differences between the mild group and moderate group[(63. 84 ± 8. 81)％ vs. (75. 06 ± 5. 07)％ ],the mild group and severe group[(63. 84 ± 8. 81)％ vs. (76. 40 ± 7. 94)]in the collapse of epiglottic area (t = 11. 22,P = 0. 000;t = - 12. 56,P = 0. 000). There was no statistically significant difference between the moderate group and severe group in the collapse of epiglottic area(P > 0. 05). Conclusion Fiberoscope combined with Müller test can respond better upper airway compliance in OSAHS patients with MSMSMS. It is worth to promote in clinic.

Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system / Comparação entre endoscopia com sono induzido por fármacos e manobra de Müller no diagnóstico de apneia obstrutiva do sono usando o sistema de classificação VOTE

Abstract Introduction: Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with Obstructive Sleep Apnea Syndrome (OSAS). To this end, several diagnostic tests and procedures have been developed. Objective: To determine whether drug-induced sleep endoscopy (DISE) or Müller's maneuver (MM) would be more successful at identifying the site of obstruction and the pattern of upper airway collapse in patients with OSAS. Methods: The study included 63 patients (52 male and 11 female) who were diagnosed with OSAS at our clinic. Ages ranged from 30 to 66 years old and the average age was 48.5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction as well as the VOTE classification. The results of each test were analyzed per upper airway level and compared using statistical analysis (Cohen's kappa statistic test). Results: There was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior (73%), lateral (92.1%), and concentric (74.6%) configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests (58.7%). Results from the lateral configuration of the epiglottis were in concordance between the tests (87.3%). There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue (23.8%) and epiglottis (42.9%). Conclusion: We suggest that DISE has several advantages including safety, ease of use, and reliability, which outweigh MM in terms of the ability to diagnose sites of obstruction and the pattern of upper airway collapse. Also, MM can provide some knowledge of the pattern of pharyngeal collapse. Furthermore, we also recommend using the VOTE classification in combination with DISE.

Resumo Introdução: O conhecimento do local da obstrução e do padrão de colapso das vias respiratórias é essencial para determinar o tratamento cirúrgico e clínico corretos de pacientes com Síndrome de Apneia Obstrutiva do Sono (SAOS). Para este fim, vários testes e procedimentos de diagnóstico foram desenvolvidos. Objetivo: Determinar se a Endoscopia de Sono Induzido por Fármacos (DISE) ou Manobra de Müller (MM) seria mais bem-sucedida na identificação do local de obstrução e do padrão de colapso das vias respiratórias superiores em pacientes com SAOS. Método: O estudo incluiu 63 pacientes (52 do sexo masculino e 11 do sexo feminino) que foram diagnosticados com SAOS em nossa clínica. As idades variaram de 30 a 66 anos e a idade média foi de 48,5 anos. Todos os pacientes foram submetidos a DISE e MM e os resultados destes exames foram caracterizados de acordo com a região/grau de obstrução, bem como a classificação VOTE. Os resultados de cada teste foram analisados de acordo com o nível das vias respiratórias superiores e comparados por análise estatística (teste estatístico kappa de Cohen). Resultados: Houve concordância estatisticamente significativa entre os resultados da DISE e MM para os procedimentos que envolvem configuração anteroposterior (73%), lateral (92,1%) e concêntrica (74,6%) do véu palatino. Os resultados da parte lateral da orofaringe também estavam em concordância entre os testes (58,7%). Os resultados da configuração lateral da epiglote estavam em concordância entre os testes (87,3%). Não houve concordância estatisticamente significativa entre os dois exames para os procedimentos que envolvem a parte anteroposterior da língua (23,8%) e epiglote (42,9%). Conclusão: Sugere-se que a DISE apresenta várias vantagens, como segurança, facilidade de uso e confiabilidade, que superam a MM em termos da capacidade de diagnosticar locais de obstrução e o padrão de colapso da via respiratória superior. O MM pode também fornecer algum conhecimento sobre o padrão de colapso da faringe. Além disso, recomendamos o uso da classificação VOTE em combinação com DISE.

Preoperative diagnosis value of sleep respiration monitoring and upper airway obstruction positioning system for patients with obstructive sleep apnea hypopnea syndrome / 第二军医大学学报

Objective To evaluate the preoperative value of the sleep respiration monitoring and upper airway obstruction positioning system ApneaGraph 200 (AG 200,JC Medical,America) in disease diagnosis (severity) and the location of upper airway obstruction plane in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of 121 suspected patients with OSAHS were randomly selected. They were examined by Müller's maneuver in the upper airway obstruction site. Then they underwent one-night (7 h) sleeping monitor by polysomnography (PSG, D-22525, Weinmann GmbH, Germany) and AG 200 simultaneously. The data obtained by PSG and AG 200 were compared, including apnea-hypopnea index (AHI), mean arterial blood oxygen saturation (mean SaO2, MSaO2), lowest arterial oxygen saturation (lowest SaO2, LSaO2), percentage of the cumulative time of SaO2≤90% to total monitoring time (CT90%) and diagnosis of the properties and the severity of upper airway obstruction. The constituent ratios of the different obstructive plane measured by AG 200 and the upper airway obstructive sites determined by Müller's maneuver were also compared. Results The AHI, MSaO2, LSaO2, CT90% and the properties and the severity of upper airway obstruction by the AG 200 and PSG were similar. The positive rates of the upper plane obstructive sites determined by the endoscopy with Müller's maneuver and AG 200 were the same. The positive rate of the down plane obstructive sites determined by AG 200 was significantly higher than that determined by the endoscopy with Müller's maneuver (P <0.05). Conclusion One-night PSG and AG 200 monitoring can simultaneously achieve accurate qualitative and primary positioning diagnosis of OSAHS. AG 200 can identify the level of upper airway obstruction more accurately when combined with the endoscopy with Müller's maneuver.