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Can drug-induced sleep endoscopy (DISE) predict compliance with positive airway pressure therapy? A pilot study

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Drug-induced sleep endoscopy (DISE) has been poorly explored as an examination to assess positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA). The present study aimed to identify by DISE possible characteristics related to low compliance with PAP therapy due to respiratory complaints.

Methods

Patients using PAP for OSA underwent DISE in two conditions: (1) baseline (without PAP) and (2) PAP (with the same mask and airway pressure used at home). We compared patients reporting low compliance to PAP due to respiratory complaints to those well-adapted to therapy. VOTE classification (assessment of velopharynx, oropharynx, tongue base, and epiglottis) and TOTAL VOTE score (the sum of VOTE scores at each anatomical site) were assessed. ROC curve analyzed the accuracy of TOTAL VOTE to predict low compliance due to persistent pharyngeal obstruction in both conditions.

Results

Of 19 patients enrolled, all presented multilevel pharyngeal obstruction at baseline condition, with no difference between groups at this study point. When PAP was added, the median VOTE value was higher in the epiglottis (P value=0.02) and tended to be higher at the velum and tongue base in the poorly adapted group; TOTAL VOTE score was also significantly increased in patients with low compliance (P value<0.001). ROC curve demonstrated that patients with TOTAL VOTE scored 2.5 or more during DISE with PAP presented a 4.6-fold higher risk for low compliance with PAP therapy due to pharyngeal obstruction (AUC: 0.88±0.07; P value<0.01; sensitivity: 77%; specificity: 83%).

Conclusions

Adding PAP during a DISE examination may help to predict persistent pharyngeal obstruction during PAP therapy.

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Acknowledgements

This clinical trial has been registered at http://www.ensaiosclinicos.gov.br/rg/RBR-9wdkjh under the number RBR-9wdkjh

This study has been funded by FAPESP—São Paulo Research Foundation (grant number 2012/10006-3, specific for the study), CNPq (grant scholarship to FCPV), and CAPES (grant scholarship to MSY).

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Authors and Affiliations

  1. ENT Division, Clinics Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes, 3900-12o andar, CEP 14049-900, Ribeirão Preto, São Paulo, Brazil

    Mariane S. Yui, Quedayr Tominaga, Daniel S. Küpper & Fabiana C. P. Valera

  2. Anesthesiology Division, Clinics Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil

    Bruno C. P. Lopes

  3. Neurosciences Division, Clinics Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil

    Alan L. Eckeli & Leila A. de Almeida

  4. Hospital Samaritano São Paulo, São Paulo, Brazil

    Fabio A. W. Rabelo

Authors
  1. Mariane S. Yui
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  2. Quedayr Tominaga
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  3. Bruno C. P. Lopes
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Correspondence to Fabiana C. P. Valera.

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Yui, M.S., Tominaga, Q., Lopes, B.C.P. et al. Can drug-induced sleep endoscopy (DISE) predict compliance with positive airway pressure therapy? A pilot study. Sleep Breath 26, 109–116 (2022). https://doi.org/10.1007/s11325-021-02360-w

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  • DOI: https://doi.org/10.1007/s11325-021-02360-w

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