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Sleep apnea is a condition where breathing stops intermittently during sleep, often leading to significant health issues. Each episode can last from 10 to 20 seconds or more and is frequently accompanied by a brief arousal from sleep. This disturbance, largely unnoticed by the individual, can lead to severe daytime fatigue. Commonly, individuals seek help after being informed by their partners about loud snoring and noticeable breathing pauses during sleep.
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Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
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CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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Updated: Aug 6, 2025

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
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Transverse Maxillary Deficiency Predicts Increased Upper Airway Collapsibility during Drug-Induced Sleep Endoscopy.

Eric Thuler1, Everett G Seay1, John Woo2,3

  • 1Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|March 20, 2023
PubMed
Summary

Craniofacial skeletal anatomy, specifically reduced transverse maxillary dimensions and increased pharyngeal length, is linked to greater pharyngeal collapse in severe obstructive sleep apnea patients. These findings suggest a role for skeletal factors in airway obstruction pathogenesis.

Keywords:
CT scancraniofacial analysismaxillary transverse deficiencysleep apneaupper airway collapse

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Area of Science:

  • Sleep Medicine
  • Otolaryngology
  • Orthodontics

Background:

  • Obstructive sleep apnea (OSA) involves upper airway collapse during sleep.
  • Craniofacial skeletal morphology is implicated in OSA pathogenesis.
  • Objective measures of pharyngeal collapsibility are crucial for understanding OSA mechanisms.

Purpose of the Study:

  • To investigate the association between craniofacial skeletal anatomy and objective measures of pharyngeal collapse.
  • To test the hypothesis that transverse maxillary deficiency and increased pharyngeal length correlate with higher pharyngeal collapsibility.

Main Methods:

  • Cross-sectional analysis of 103 patients with severe OSA undergoing computed tomography (CT) and drug-induced sleep endoscopy.
  • CT assessed transverse maxillary dimensions and pharyngeal length.
  • Pharyngeal critical pressure (PCRIT) and pharyngeal opening pressure (PhOP) were determined via positive airway pressure (PAP) titration.

Main Results:

  • Reduced transverse maxillary dimensions (interpremolar and intermolar distances) were associated with higher PCRIT and PhOP.
  • Longer pharyngeal length was also significantly associated with increased PCRIT and PhOP.
  • These associations remained significant after adjusting for sex, age, height, and BMI.

Conclusions:

  • Skeletal restriction in the transverse dimension and increased pharyngeal length are linked to elevated pharyngeal collapsibility during sleep.
  • Transverse deficiency may play a role in the development of upper airway obstruction in OSA.
  • Findings support the integration of craniofacial skeletal analysis in OSA evaluation and management.