Correlation of site of obstruction between two dynamic evaluation modalities in obstructive sleep apnea patients: drug-i
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ENT • ORIGINAL ARTICLE
Correlation of site of obstruction between two dynamic evaluation modalities in obstructive sleep apnea patients: drug-induced sleep endoscopy and sleep videofluoroscopy Tae-Bin Won 1,4 & Dong-Kyu Kim 2 & Jee Hye Wee 3 & Jeong-Whun Kim 1 & Sung-Woo Cho 1 & Hyun Jik Kim 4 & Dong-Young Kim 4 & Chae Seo Rhee 4 Received: 1 May 2020 / Revised: 12 August 2020 / Accepted: 13 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose Drug-induced sleep endoscopy (DISE) and sleep videofluoroscopy (SVF) are two dynamic modalities for evaluating the upper airway in patients with obstructive sleep apnea (OSA). We evaluated the correlation of obstructive sites determined by DISE and SVF in OSA patients and elucidate findings that can improve the accuracy of upper airway assessment. Methods A consecutive series of 63 patients with OSA who underwent DISE and SVF were the subjects of this study. The DISE and SVF findings were divided according to the anatomical structure responsible for the collapse, including the soft palate (SP), oropharyngeal lateral walls (LW), tongue base (TB), and larynx (LX). The obstruction was graded on the three-point scale: 0, no obstruction; 1, partial obstruction; or 2, complete obstruction. Additionally, grade 1.5 TB obstruction was designated when the posterior displacement of the anterior tongue was detected during simultaneous retropalatal obstruction. The agreement rate and Cohen’s kappa test between the two modalities were also assessed. Results The agreement rate between the two modalities was highest in LX (88.9%) followed by SP (85.7%), TB (76.1%), and LW (74.6%) (Cohen’s kappa value = 0.757 in LX, 0.642 in SP, 0.637 in TB, 0.612 in LW, respectively). When grade 1.5 and 2 TB obstructions were combined, the agreement rate increased to 88.9% (Cohen’s kappa value = 0.757). Conclusions We found a good overall agreement between the two dynamic airway evaluation modalities during drug-induced sleep, and this correlation may be improved if the posterior displacement of the anterior tongue during DISE is used as a sign of TB obstruction. Keywords Obstructive sleep apnea . Drug-induced sleep endoscopy . Tongue base . Retroglossal . Sleep videofluoroscopy
Introduction Obstructive sleep apnea (OSA), caused by partial or complete obstruction of the upper airway during sleep, is a common
sleep-related breathing disorder, afflicting about 2–4% of the adult population [1]. The treatment of patients with OSA involves the elimination of the obstruction in the upper airway during sleep by the use of a variety of treatment modalities
Tae-Bin Won and Dong-Kyu Kim contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11325-020-02225-8) contains supplementary material, which is available to authorized users. * Tae-Bin Won [email protected] * Dong-Kyu Kim [email protected] 1
Department of Otorhinolaryngology-HNS, Seoul National University Bundang Hospital, Seoul National University College of Medicine,
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