The definitive resource on the innovative use of DISE for obstructive sleep apnea
Obstructive sleep apnea is the most prevalent sleep-related breathing disorder, impacting an estimated 1.36 billion people worldwide. In the past, OSA was almost exclusively treated with Continuous Positive Airway Pressure (CPAP), however, dynamic assessment of upper airway obstruction with Drug-Induced Sleep Endoscopy (DISE) has been instrumental in developing efficacious alternatives. Drug-Induced Sleep Endoscopy: Diagnostic and Therapeutic Applications by Nico de Vries, Ottavio Piccin, Olivier Vanderveken, and Claudio Vicini is the first textbook on DISE written by world-renowned sleep medicine pioneers.
Twenty-four chapters feature contributions from an impressive group of multidisciplinary international experts. Foundational chapters encompass indications, contraindications, informed consent, organization and logistics, patient preparation, and drugs used in DISE. Subsequent chapters focus on treatment outcomes, the role of DISE in therapeutic decision making and upper airway stimulation, pediatric sleep endoscopy, craniofacial syndromes, advanced techniques, and more.
Key Highlights
- Comprehensive video library highlights common and rare DISE findings
- A full spectrum of sleep disordered breathing and OSA topics, from historic to future perspectives
- Insightful clinical pearls on preventing errors and managing complications including concentric and epiglottis collapse
- Discussion of controversial DISE applications including oral appliances and positional and combination therapies
This unique book is essential reading for otolaryngology residents, fellows, and surgeons. Clinicians in other specialties involved in sleep medicine will also benefit from this reference, including pulmonologists, neurologists, neurophysiologists, maxillofacial surgeons, and anesthesiologists.
This book includes complimentary access to a digital copy on https://medone.thieme.com.
Author(s): Nico de Vries, Ottavio Piccin, Olivier M. Vanderveken, Claudio Vicini
Publisher: Thieme
Year: 2021
Language: English
Pages: 148
City: New York
Drug-Induced Sleep Endoscopy: Diagnostic and Therapeutic Applications
MedOne Access Information
Title Page
Copyright
Contents
Videos
Preface
Contributors
1 Introduction
1.1 Obstructive Sleep Apnea
2 Historical Perspective
2.1 Introduction
2.2 The Original Concept
2.2.1 Early Work
2.2.2 The Origins of DISE
2.2.3 History of DISE-Controversies
2.3 Interpretation-Grading
2.4 Evolving Technology
3 Applicability
3.1 Introduction
3.2 Comparisons of Natural Sleep and Sedation
3.2.1 Respiratory Parameters
3.2.2 Critical Closing Pressure
3.2.3 Other Variables
3.3 DISE Validity and Sedation Method
4 Classifications Systems
4.1 Introduction
4.2 Anatomy
4.3 Main Elements that a DISE Scoring System Should Have
4.4 Common Classification Systems
4.4.1 Pringle and Croft
4.4.2 The VOTE Classification
4.4.3 The NOHL Classification
4.4.4 Bachar's Classification
4.4.5 Woodson's Classification
4.4.6 Other Mixed Classifications
4.4.7 Pediatric Classifications
4.5 Localization of the Tip of the Endoscope
4.6 Images of Collapses
4.7 Conclusions
5 Indications and Contraindications
5.1 Introduction and Definitions
5.2 Geographical Differences
5.3 DISE in Naive OSA Patients
5.4 DISE in Positional OSA
5.5 DISE and UA Surgery
5.6 DISE in Simple Snorers
5.7 DISE after UA Surgery, MAD, and UA Stimulation Treatment Failure
5.8 DISE after Weight Loss
5.9 DISE and CPAP Failure
6 Preparation for DISE: Informed Consent
6.1 Introduction
7 Organization and Logistics
7.1 Introduction
7.2 Materials and Methods
7.2.1 History of DISE in Our Hospital
7.2.2 Patient Indication for DISE
7.2.3 Staff
7.2.4 Sedation Protocol
7.2.5 Logistics
7.2.6 DISE Report
7.3 Results
7.4 Discussion
7.5 Conclusion
8 Patient Preparation and Positioning
8.1 Introduction
8.2 Preoperative Preparation
8.3 Operation Theatre Preparation
8.4 Patient Preparation
8.5 Patient Positioning
8.6 Positioning of the Endoscopist in Performing DISE
8.7 Interventional DISE
8.8 Conclusion
9 Drugs for DISE
9.1 Introduction
9.2 Effects of Local Anesthesia and Nasal Decongestion
9.3 Drugs Used for DISE
9.3.1 Propofol
9.3.2 Midazolam
9.3.3 Dexmedetomidine
9.4 Dosage of Drugs
9.4.1 Dosage of Propofol
9.4.2 Dosage of Midazolam
9.4.3 Dosage of Dexmedetomidine
10 An Anesthesiological Point of View
10.1 Introduction
10.2 General Anesthesia, Sedation and Sleep: Similarities and Differences
10.3 Anesthetics and Upper Airway
10.4 How to Monitor Sedation
10.5 Propofol and TCI Technology
10.6 Difficult Airway in OSA: Prediction and Management Strategy
10.6.1 Face Mask Ventilation and SADs
10.6.2 Direct Laryngoscopy versus Videolaryngoscopy
10.7 Perioperative Care
10.8 Special Considerations in Pediatric Population
10.9 Conclusion
11 Work in Progress: A Prediction Model for DISE as Selection Tool for MAD and Positional Therapy
11.1 Introduction
11.2 Methods
11.2.1 Patients
11.2.2 DISE Procedure
11.2.3 Classification System
11.2.4 Statistical Analysis
11.3 Results
11.4 Discussion
11.5 Conclusion and Future Perspectives
12 Complications of DISE
12.1 Introduction
12.2 Background
12.3 Complications
12.3.1 Equipment Factors
12.3.2 Anesthetic Factors
12.3.3 Patient Factors
12.3.4 Recommendations
12.4 Discussion
13 DISE and Treatment Outcome
13.1 Introduction
13.2 Predictive Value
13.3 Treatment Outcome Per Modality
13.3.1 Pharyngeal Surgery
13.3.2 Hypoglossal Nerve Therapy
13.3.3 Transoral Robotic Surgery
13.3.4 Maxillomandibular Advancement (MMA)
13.3.5 Positional Therapy
13.4 DISE in Surgical Failures
14 DISE and Position-Dependent OSA
14.1 Positional Sleep Apnea
14.2 Management of POSA
14.3 Characteristics of Patients with POSA
14.4 DISE and POSA
14.5 Surgery and POSA
15 Significance of Complete Concentric Collapse of the Palate
15.1 Introduction
15.2 Pathophysiology: Upper Airway Shape and Collapsibility
15.3 Predictive Value on Treatment Outcome
15.3.1 Pharyngeal Surgery
15.3.2 Upper Airway Stimulation (UAS)
15.3.3 Mandibular Advancement Device Treatment
15.3.4 Maxillomandibular Advancement Surgery
15.4 Summary
16 Epiglottic Collapse
16.1 Introduction
16.2 Material and Methods
16.2.1 Patients
16.2.2 Definitions
16.2.3 DISE Procedure
16.2.4 Patient Positioning
16.3 Results
16.3.1 DISE Findings
16.4 Discussion
16.5 Conclusion
16.6 Clinical Relevance
17 Common Mistakes in DISE
17.1 Introduction
17.2 Setting and Preoperative Investigations
17.3 Technical Equipment
17.4 Patient Positioning and Diagnostic Maneuvers
17.5 Observation Window
17.6 Target Events
17.7 Classification System
17.8 Counseling after DISE
17.9 Conclusion
18 Diagnostic and Therapeutic Applications or a Guide for Clinical Practice
18.1 History
18.1.1 History about Hypoglossal Nerve Stimulation
18.1.2 History about DISE in Selective HN Stimulation-The Key Factor to Success
18.2 Hypoglossal Nerve Anatomy
18.3 Pathophysiology and Mechanisms of Stimulation
18.3.1 Anatomical Pattern and Level of Obstructions in the Pathophysiology of OSA
18.4 DISE in HNS as a Screening Tool-Procedure for Best Practice
18.5 Analyzing the Results of DISE in Patients with Breathing-Synchronized HNS
18.6 Using DISE as a Titration Tool for Hypoglossal Nerve Stimulation (HNS)
19 DISE and Treatment with Mandibular Advancement Devices in Obstructive Sleep Apnea Patients
19.1 Introduction
19.2 MAD Treatment Success
19.3 DISE as a Screening Tool for MAD Treatment
19.4 Thermoplastic Appliances
19.5 Simulation Bite and a Remotely Controlled Mandibular Positioner
19.6 Conclusions
20 The Use of DISE to Determine Candidates for Upper Airway Stimulation
20.1 Introduction
20.2 Upper Airway Stimulation (UAS)
20.2.1 History of UAS
20.2.2 UAS Components
20.2.3 Mechanism of UAS
20.2.4 Selection Criteria for UAS
20.2.5 Outcomes of UAS
20.3 Clinical History and Data
20.3.1 DISE for UAS Candidacy
20.3.2 Improving UAS Efficacy Using DISE
20.4 Conclusions
21 Pediatric Sleep Endoscopy
21.1 Introduction
21.2 Sites of Potential UA Obstruction in Children
21.2.1 The Nose and Nasopharynx
21.2.2 Oropharynx: Tonsils and Lateral Pharyngeal Wall
21.2.3 Tongue Base
21.2.4 Epiglottis
21.2.5 Supraglottis-Sleep-Dependent or Late Onset Laryngomalacia
21.2.6 Evaluation of the Lower Airways
21.3 Drug Used for Pediatric DISE
21.4 Indications for DISE
21.4.1 Commonly Accepted Indications for DISE in Children
21.4.2 Expanding Indications for Pediatric DISE
21.5 DISE Protocol
21.6 DISE Scoring Systems
21.7 Outcome of DISE-Directed Surgery in Children
21.7.1 Surgically Naive, Healthy Patients with OSAS
21.7.2 Children with Persistent OSAS with/without Comorbidity
21.7.3 Children with Hypotonia
21.7.4 Children with Down Syndrome
21.8 Clinical Case Scenarios
21.8.1 Case 1
21.8.2 Case 2
21.9 Role of DISE in the Multidisciplinary and Integrated Approach to Pediatric OSAS
22 DISE in Children with Craniofacial Anomalies
22.1 Introduction
22.1.1 Types of Craniofacial Diseases and OSA
22.1.2 Cleft Lip and/or Palate
22.1.3 Synostoses
22.1.4 Hypoplasia
22.2 Rationale for DISE in Children with Craniofacial Anomalies
22.3 Conclusions
23 Advanced Technique
23.1 Introduction
23.2 Indications
23.2.1 Assessment before A-DISE
23.2.2 Titration Approach for Oral Device Simulator
23.2.3 A-DISE Protocol
23.3 Potential Advantages from Conventional Technique
24 Future Perspectives
24.1 Patient Phenotyping/Endotyping
24.1.1 Deficient Upper Airway Anatomy
24.1.2 Muscle Responsiveness
24.1.3 Loop Gain
24.1.4 Respiratory Arousal Threshold
24.1.5 PALM Scale for Patient Phenotyping
24.1.6 Phenotyping/Endotyping Conclusions
24.2 Analysis of Airflow Shape
24.3 Radiological Sleep Assessment
24.4 Real-Time Sleep Videomanometry
24.5 Conclusions
Index
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