Novel Intraoral Negative Airway Pressure in Drug-Induced Sleep Endoscopy with Target-Controlled Infusion

Area of Science:

• Sleep Medicine
• Respiratory Physiology
• Otolaryngology

Background:

• Obstructive sleep apnea (OSA) is a common sleep disorder characterized by airway obstruction.
• Continuous positive airway pressure (CPAP) therapy is a standard treatment, but some patients are intolerant.
• Intermittent negative airway pressure (iNAP) therapy offers an alternative by repositioning soft tissues to reduce airway collapse.

Purpose of the Study:

• To investigate the efficacy of iNAP therapy during drug-induced sleep endoscopy (TCI-DISE) in OSA patients.
• To assess the impact of iNAP on upper airway obstruction severity.
• To evaluate the potential of TCI-DISE as a screening tool for iNAP therapy responders.

Main Methods:

• A prospective case series of 92 OSA patients undergoing TCI-DISE with iNAP.
• Upper airway obstruction was assessed using the velum, oropharynx, tongue base, and epiglottis (VOTE) classification.
• Obstruction severity was evaluated in supine position with and without iNAP, and with iNAP combined with head rotation.

Main Results:

• iNAP therapy in the supine position significantly reduced obstruction severity in patients with velar, oropharyngeal, and tongue base obstruction.
• Combining iNAP with head rotation further decreased obstruction severity in patients with velar, tongue base, and epiglottic obstruction.
• Significant improvements were observed in a substantial percentage of patients for each obstruction type.

Conclusions:

• iNAP therapy effectively alleviates velar, oropharyngeal, and tongue base obstruction in OSA patients during TCI-DISE.
• Combining iNAP with positional therapy can further reduce airway obstruction, including epiglottic obstruction.
• TCI-DISE serves as an efficient method for screening potential responders to iNAP therapy, being less time-consuming than polysomnography (PSG).