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Inicio Acta Otorrinolaringológica Española Upper airway assessment in obstructive sleep apnea patients: can computed tomogr...
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Vol. 74. Issue 5.
Pages 290-297 (September - October 2023)
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Vol. 74. Issue 5.
Pages 290-297 (September - October 2023)
Original article
Upper airway assessment in obstructive sleep apnea patients: can computed tomography with lateral cephalometry replace drug-induced sleep endoscopy (DISE)?
Evaluación de la vía aérea superior en pacientes con apnea obstructiva del sueño: ¿puede la tomografía computarizada con cefalometría lateral reemplazar endoscopia del sueño inducida por fármacos por fármacos?
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Ana Camposa,
Corresponding author
, Pedro Cebolab,c, Sara Simões Diasd, José Pedro Paisa, Susana Sousac, Sérgio Cardosoc,e, João Paçoc,f, Cristina Caroçac,f
a Otorhinolaryngology Clinical Academic Nucleus, Hospital CUF Tejo, Lisbon, Portugal
b Otorhinolaryngology Clinical Academic Nucleus, Hospital CUF Tejo, Lisbon, Portugal, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal
c Sleep Medicine Unit, Hospital CUF Tejo, Lisbon, Portugal
d EpiDoC Unit–CEDOC, NOVA Medical School, Lisbon, Portugal. ciTechCare - Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
e Radiology Department, Hospital CUF Tejo, Lisbon, Portugal
f Otorhinolaryngology Clinical Academic Nucleus, Hospital CUF Tejo, Lisbon, Portugal, NOVA Medical School, Lisbon, Portugal, Comprehensive Health Research Center, Lisbon, Portugal
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Figures (2)
Tables (4)
Table 1. VOTE classification structure used routinely and the one used in this study outlined in darker.
Table 2. Normal range of the measures considered in this study.
Table 3. Study population collected data.
Table 4. DISE results according to VOTE classification.
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Abstract
Objective

To evaluate the association between results from drug-induced sleep endoscopy (DISE) and computed tomography with lateral cephalometry (CTLC) of the pharynx in obstructive sleep apnea (OSA) patients, regarding the same anatomic level, in order to understand if CTLC could replace DISE in selected patients.

Study design

Cross-sectional.

Setting

Tertiary hospital.

Methods

A total of 71 patients who attended the Sleep Medicine Consultation in the Otorhinolaryngology Department of Hospital CUF Tejo between 1.6.2019 and 30.9.2021, performed a polysomnographic sleep study and were elected to undergo DISE and CTLC of the pharynx for diagnostic purposes were selected. Obstructions at the same anatomic levels – tongue base, epiglottis and velum - were compared in both exams.

Results

Patients with reduction of epiglottis-pharynx space on CTLC had also a complete obstruction at epiglottis level on the VOTE classification of DISE (p = 0,027). Reduction of velum-pharynx space or tongue base-pharynx space were not related to complete obstruction of the velum (P = 0,623) or the tongue base (p = 0,594) found in DISE. Those with two or more space reductions had a tendency to multilevel obstruction observed in DISE (p = 0.089).

Conclusion

When evaluating the obstruction level(s) of an OSA patient, efforts should be made to perform DISE, since CTLC measures, though regarding at the same structures, don´t correlate completely with obstructions observed in DISE.

Keywords:
Obstructive sleep apnea
Drug-induced sleep endoscopy
DISE
Computed tomography with lateral cephalometry
Resumen
Objetivo

Evaluar la asociación entre los resultados de la endoscopia del sueño inducida por fármacos (DISE) y la tomografía computarizada con cefalometría lateral (TCCL) de faringe en pacientes con apnea obstructiva del sueño (AOS), en el mismo nivel anatómico, para comprender si la TCCL podría reemplazar DISE en pacientes seleccionados.

Diseño del estudio

Transversal.

Lugar

Hospital de tercer nivel.

Métodos

Un total de 71 pacientes que acudieron a la Consulta de Medicina del Sueño en el Servicio de Otorrinolaringología del Hospital CUF Tejo entre el 1.6.2019 y el 30.9.2021, a los que se les había realizado un estudio polisomnográfico del sueño y fueron elegidos para realizar DISE y TCCL de faringe con fines diagnósticos, fueron seleccionados. Las obstrucciones en los mismos niveles anatómicos (base de la lengua, epiglotis y velo) se compararon en ambos exámenes.

Resultados

Los pacientes con reducción del espacio epiglotis-faringe en TCCL también tenían una obstrucción completa a nivel de epiglotis en la clasificación VOTE de DISE (p = 0,027). La reducción del espacio velo-faringe o base de la lengua-faringe no se relacionó con la obstrucción completa del velo (P = 0,623) o de la base de la lengua (p = 0,594) encontrada en DISE. Aquellos con dos o más reducciones de espacio presentaron tendencia a la obstrucción multinivel observada en DISE (p = 0,089).

Conclusión

Al evaluar el o los niveles de obstrucción de un paciente con AOS, se debe intentar realizar DISE, ya que las medidas de TCCL, aunque se refieren a las mismas estructuras, no se correlacionan completamente con las obstrucciones observadas en DISE.

Palabras clave:
Apnea obstructiva del sueño
Endoscopia del sueño inducida por fármacos
DISE
Tomografía computarizada con cefalometría lateral

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