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Updated: Jun 27, 2026
Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Diaphragm plication reduces sleep-related obstructive disturbances in surgically selected patients with unilateral
Julie Molle1, Christian Straus2, Valérie Attali3
1AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Département R3S, Paris, France; Centre Hospitalier Général d'Antibes, Service de pneumologie, Antibes, France.
Introduction:
Unilateral diaphragmatic dysfunction can cause exertional and postural dyspnoea, along with sleep-related breathing disturbances. Diaphragm plication alleviates daytime symptoms, but its effects on sleep have not been evaluated in detail.
Methods:
We analysed prospectively collected observational data in 12 patients undergoing surgical plication for unilateral diaphragmatic dysfunction. Standardised pre- and postoperative assessments included ratings of exertional dyspnoea, orthopnoea and antepnoea (D-VAS), quality of life (VSRQ), spirometry (sitting and supine), transdiaphragmatic twitch pressures, and polysomnography (PSG). Sleep-disordered breathing was evaluated using standard PSG indices including the obstructive apnoea-hypopnoea index (oAHI), measured globally and during REM.
Results:
Following plication, dyspnoea decreased and orthopnoea and antepnoea were nearly abolished (p = 0.0123 and p = 0.0001, respectively). VSRQ improved (p = 0.0078). Supine vital capacity rose from 52.5% to 75.0% predicted (p = 0.0010), and supine VC drop decreased from 15.1% to 2.65% (p = 0.0068). Twitch pressures increased significantly. oAHI decreased from 15.5 to 8.5 events·h⁻¹ (not significant after multiplicity correction). REM AHI decreased from 43.0 [24.5-66.9] to 19.0 [11.5-23.3] events·h⁻¹ (p = 0.0020), and REM hypopnoea index from 19.5 to 11.0 (p = 0.0098). Strong correlations were found between REM AHI changes and both FRC and expiratory reserve volume (ERV).
Conclusion:
In patients with unilateral diaphragmatic dysfunction, diaphragm plication is associated with improved REM-related obstructive events. This may relate to lung volume restoration. These exploratory findings suggest that prospective studies are needed to determine the usefulness of systematic pre-post plication PSG for patient selection and outcome evaluation.
