ABSTRACT
Patients with sleep-disordered breathing (SDB) suffer from repetitive upper airway
occlusion. Various techniques have been described to assess the site of upper airway
collapse. In most cases the soft palate or the base of tongue, or both, are the major
levels of obstruction; rarely, the larynx, including the epiglottis, are found to
be involved. We present five cases in which sleep videoendoscopy finally revealed
the true mechanism of the inspiratory airway behavior. Two patients were sent to our
service because of inefficacy of nasal ventilation therapy. One had a floppy epiglottis
that was being sucked into the glottis. The other had a normal larynx during videoendoscopy.
Instead, common pharyngeal collapse could be detected. Increasing the pressure normalized
sleep, breathing, and videoendoscopy. The third patient showed apneas due to the adduction
of the lateral parts of his omega-shaped epiglottis. In another case, inspiratory
fluttering of the vocal cords caused snoring and arousals. The last case came in for
bilateral vocal cord palsy with heavy nocturnal desaturations suggesting airway closure.
Yet, the pharynx and larynx remained open throughout the night. Sleep videoendoscopy
is a convenient method to define the level and mechanism of occlusion in obstructive
SDB, particularly if the larynx is involved. It is useful to rule out airway compromise
in case of recurrent nocturnal hypoxemias. Thus the results of sleep videoendoscopy
have a strong therapeutical impact.
KEYWORD
obstructive sleep apnea - videoendoscopy - larynx - epiglottis
