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

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Abstract

Purpose

Drug-induced sleep endoscopy (DISE) is commonly performed in patients suffering obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) intolerance. We aimed to evaluate the effects of adding CPAP to DISE to provide understanding of the reason of its failure and better guidance in future therapeutic decisions.

Methods

A retrospective observational descriptive study was conducted on CPAP-intolerant patients with moderate-severe OSA. DISE was used to evaluate upper airway collapsibility, and CPAP was tested to better describe anatomical sites of obstruction and to measure the opening pharyngeal pressure.

Results

Sample size consisted of 38 patients with a mean age of 49 ± 9 years. Mean BMI was 28.4 ± 2.4 kg/m2, mean apnea–hypopnea index (AHI) was 35.4 events per hour ± 20.1, and mean saturation under 90% (TSat90) was 14.5%. In DISE we found a collapse at Velum in 92% of patients, at Oropharyngeal level in 89%, at tongue in 42%, and at epiglottis in 36%. In the subgroup of patients with clinical failure with CPAP, we observed 100% of epiglottic collapse and 50% of tongue obstruction. In this specific population, we recommended personalized surgery and myofunctional therapy.

Conclusion

DISE-CPAP is a useful tool to select the treatment that better fits to each patient taking care all information available. It improves our ability to prescribe a multilevel treatment with an exhaustive topographic evaluation of upper airway collapsibility that complements CPAP classic titration, and it can be helpful to distinguish better candidates for surgery, myofunctional therapy or CPAP.

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Data availability

We could provide the database available to revise if needed.

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Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Hospital QuirónSalud San Jose, Calle Cartagena 111, 28002, Madrid, Spain

    Marta Morato

  2. Department of Otolaryngology, Hospital Sanitas La Moraleja, Madrid, Spain

    Marta Alcaraz

  3. Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain

    Gabriela Bosco, Nuria Pérez-Martín & Estefanía Miranda

  4. Department of Otolaryngology, Hospital Quirónsalud Marbella, Marbella, Spain

    Carlos O’Connor-Reina

  5. Department of Pneumology, Hospital Universitario Central de Asturias, Oviedo, Spain

    Juan Alejandro Cascón

  6. Department of Otolaryngology, Hospital Universitario de Fuenlabrada and Hospital Sanitas La Zarzuela, Universidad Rey Juan Carlos, Madrid, Spain

    Guillermo Plaza

Authors
  1. Marta Morato
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  2. Marta Alcaraz
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  3. Gabriela Bosco
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Correspondence to Marta Morato.

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All authors certify that they have no affiliation or involvement with any organization or entity that has any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki. The Research Ethics Committee of the hospital approved the study protocol (IRB 23/71).

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Morato, M., Alcaraz, M., Bosco, G. et al. DISE with CPAP: a useful procedure to evaluate upper airway collapsibility. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08618-9

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