Dr. Kezirian is currently supported by a career development award from the National Center for Research Resources (NCRR) of the National Institutes of Health and a Triological Society Research Career Development Award of the American Laryngological, Rhinological, and Otological Society. The project was supported by NIH/NCRR/OD UCSF-CTSI Grant Number KL2 RR024130. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Sleep: Triological Society Candidate Thesis
Version of Record online: 6 MAY 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 6, pages 1320–1326, June 2011
How to Cite
Kezirian, E. J. (2011), Nonresponders to pharyngeal surgery for obstructive sleep apnea: Insights from drug-induced sleep endoscopy. The Laryngoscope, 121: 1320–1326. doi: 10.1002/lary.21749
Financial disclosures: Apnex Medical (medical advisory board, consultant), ArthroCare (consultant), Medtronic (consultant), Pavad Medical (consultant), ReVENT Medical (medical advisory board).
The author has no conflicts of interest to declare.
- Issue online: 19 MAY 2011
- Version of Record online: 6 MAY 2011
- Manuscript Accepted: 18 JAN 2011
- Manuscript Received: 3 DEC 2010
- Obstructive sleep apnea;
- drug-induced sleep endoscopy;
- sleep nasendoscopy;
- genioglossus advancement;
- tongue radiofrequency;
- Level of evidence: 4.
To examine drug-induced sleep endoscopy (DISE) findings in nonresponders to previous pharyngeal obstructive sleep apnea (OSA) surgery.
DISE using propofol for unconscious sedation was performed in nonresponders to previous OSA surgery (including palate surgery with or without tonsillectomy and possible other procedures). Nonresponders were defined as subjects with a postoperative apnea-hypopnea index more than 10 events/hr. Recorded findings from DISE included the presence and degree of obstruction in the palatal and hypopharyngeal regions, the contributions of specific structures (velum, oropharyngeal lateral walls, tongue, and/or epiglottis) to upper airway obstruction, and the degree of mouth opening.
Thirty-three nonresponders underwent DISE examinations. Age was 46.2 ± 11.8 years, and 9% (3 of 33) were female. On diagnostic sleep studies prior to DISE, the apnea–hypopnea index was 43.4 ± 26.6 events/hr. During DISE, a majority of subjects demonstrated residual palatal obstruction, and almost all demonstrated hypopharyngeal obstruction. A diversity of individual structures contributed to upper airway obstruction, often in combination. Moderate to severe mouth opening occurred in one-third of subjects and was associated with narrowing of upper airway dimensions.
Residual upper airway obstruction in surgery nonresponders likely occurs due to multiple mechanisms, and DISE may enhance the understanding of them.