DISE with CPAP: a useful procedure to evaluate upper airway collapsibility

Area of Science:

• Sleep Medicine
• Otolaryngology
• Respiratory Medicine

Background:

• Obstructive sleep apnea (OSA) is a common condition often treated with continuous positive airway pressure (CPAP).
• CPAP intolerance is a significant challenge, necessitating alternative or adjunctive diagnostic methods.
• Drug-induced sleep endoscopy (DISE) is utilized to assess airway collapse during sleep.

Purpose of the Study:

• To evaluate the efficacy of combining DISE with CPAP.
• To understand the reasons for CPAP failure in OSA patients.
• To improve therapeutic decision-making for CPAP-intolerant individuals.

Main Methods:

• A retrospective observational study of 38 moderate-to-severe OSA patients with CPAP intolerance.
• DISE was performed to assess upper airway collapsibility.
• CPAP was applied during DISE to identify obstruction sites and determine opening pharyngeal pressure.

Main Results:

• Velum collapse occurred in 92% of patients, oropharyngeal in 89%, tongue in 42%, and epiglottis in 36%.
• Patients with CPAP failure showed 100% epiglottic collapse and 50% tongue obstruction.
• Recommended personalized surgery and myofunctional therapy for this subgroup.

Conclusions:

• DISE-CPAP is a valuable tool for personalized OSA treatment selection.
• It enhances the understanding of upper airway collapsibility for multilevel treatment planning.
• This method aids in identifying suitable candidates for surgery, myofunctional therapy, or CPAP.