Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction?

The objective of the study is to assess the correlation between outpatient department (OPD) assessment and sleep nasendoscopy (SNE) in treatment planning for sleep related breathing disorders. The study design includes a blinded, cohort study comparing the treatment prediction based on OPD clinical evaluation with SNE in consecutive, adult patients by a single clinician with a specialist interest in snoring related disorders. Patients with moderate to severe obstructive sleep apnoea and those who had undergone previous treatment were excluded. The study was conducted in Royal National Throat, Nose and Ear Hospital, London and Queen's Hospital, Romford. Ninety-four patients were recruited as participants for the study. The main outcome measures include site of obstruction and treatment planning. The results show no significant correlation between the two groups with SNE recommending less surgical intervention and a choice of surgical and non-surgical management in greater number of patients. In conclusion, even in experienced hands, clinical prediction is significantly modified by SNE findings. The addition of SNE to the diagnostic pathway, to assess the three-dimensional dynamic anatomy of the upper airway, provides a valuable adjunct to the OPD assessment of upper airway collapse. This affords the clinician a greater accuracy of diagnosis and the patient a more focussed management strategy with increased choice of modality of treatment.