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Eur Arch Otorhinolaryngol. 2018 Jan;275(1):239-245. doi: 10.1007/s00405-017-4746-x. Epub 2017 Oct 3.

Reduced upper obstructions in N3 and increased lower obstructions in REM sleep stage detected with manometry.

Author information

1
Department of Otolaryngology, Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Muenchen, Germany. markus.wirth@tum.de.
2
Department of Otolaryngology, Head and Neck Surgery, Technical University of Munich, Klinikum rechts der Isar, Hals-Nasen-Ohren-Klinik, Ismaninger Straße 22, 81675, Muenchen, Germany.
3
Department of Anesthesiology, Technical University of Munich, Ismaninger Straße 22, 81675, Muenchen, Germany.
4
Institute of Medical Statistics and Epidemiology, Technical University of Munich, Ismaninger Straße 22, 81675, Muenchen, Germany.

Abstract

In obstructive sleep apnea (OSA), airway obstruction occurs at different anatomic levels. The frequency and location of obstructions play a crucial role in the planning of surgical treatment. The aim of this study was to evaluate the pharyngeal obstruction levels in different sleep stages with manometry in OSA patients. In addition, the manometry results were compared with drug-induced sleep endoscopy (DISE). Forty-one patients with OSA received manometry measurements during one night of sleep. All patients were simultaneously evaluated with polysomnography. The frequency of obstructions in different sleep stages was assessed. Twenty patients were additionally studied with DISE. Obstruction levels detected with manometry were compared with DISE. The frequency of upper and to a lesser extent lower obstructions decreased in sleep stage N3. In rapid eye movement (REM) sleep, lower obstructions increased. The overall proportion of upper and lower obstructions detected with manometry corresponded with DISE in 13 of 20 cases. A significant change in the obstruction levels was detected with manometry in N3 and REM sleep. The reduction of both upper and to a lesser extent lower obstructions in N3 suggests more stable airways in slow-wave sleep. Relevant lower obstructions were not detected in DISE compared to manometry in 5 out of 20 examinations. This could be a potential reason for treatment failure of site-specific surgical OSA treatment when only performing DISE preoperatively. Therefore, manometry could be a useful complementary tool in the preoperative evaluation for OSA.

KEYWORDS:

DISE; Manometry; Obstruction level; Polysomnography

PMID:
28975391
DOI:
10.1007/s00405-017-4746-x
[Indexed for MEDLINE]

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