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Laryngoscope. 2018 Dec 27. doi: 10.1002/lary.27655. [Epub ahead of print]

Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study.

Author information

1
Department of Otolaryngology, University of Colorado School of Medicine, Denver, Colorado, U.S.A.
2
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
3
Southern New England Ear, Nose and Throat Group, Middlesex, Connecticut, USA.
4
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
5
University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, Michigan, U.S.A.
6
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.
7
UPMC Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
8
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Memphis, Memphis, Tennessee, U.S.A.
9
Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A.
10
ENT department, Hospital Universitario Dr. Peset, Valencia, Spainc.
11
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsi, Milwaukee, Wisconsin, U.S.A.
12
ENT and Allergy Associates, New York, New York, U.S.A.
13
Department of Otolaryngology, The Mount Sinai Hospital, New York, New York, U.S.A.
14
Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
15
Department of Otolaryngology Head and Neck Surgery, Uniformed Services University, Washington, D.C., U.S.A.
16
Endormir Sleep and Sinus Institute, San Antonio, Texas, U.S.A.
17
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.
18
Department of Otolaryngology, Head and Neck Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A.
19
University of Oklahoma Health Sciences Center, Department of Otolaryngology-Head & Neck Surgery, Oklahoma City, Oklahoma, U.S.A.
20
Department of Otolaryngology Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.
21
USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.

Abstract

OBJECTIVE:

To evaluate the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort.

METHODS:

Retrospective, multi-center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression.

RESULTS:

Two hundred seventy-five study participants were included from 14 centers. Mean age was 51.4 ± 11.8 years, and body mass index was 30.1 ± 5.2 kg/m2 . There was moderate interrater reliability (kappa = 0.40-0.60) for DISE findings. Oropharyngeal lateral wall-related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue-related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum-related obstruction or the degree of epiglottis-related obstruction. Surgical response was associated with tonsil size and body mass index (inversely).

CONCLUSION:

DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation technique.

LEVEL OF EVIDENCE:

2b Laryngoscope, 2018.

KEYWORDS:

Surgery; drug-induced sleep endoscopy; endoscopy; obstructive; sleep apnea

PMID:
30588639
DOI:
10.1002/lary.27655

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