Sleep endoscopy for improved patient selection before surgical therapy of obstructive sleep apnea – A clinical case series

Introduction According to the current S3 guideline, tonsillectomy (TE) with/without uvulopalatopharyngoplasty (UPPP) may be considered for the treatment of obstructive sleep apnea (OSA) with tonsillar hyperplasia. Selection of appropriate patients is a keystone for therapeutic success. In addition to assessing awake anatomy, drug-induced sleep endoscopy (DISE) allows determination of the location and extent of upper airway obstruction in a    sleep-like state. Thus, an individualized treatment plan can be developed.

Methods This retrospective case series included 15 patients who underwent DISE followed by TE with/without UPPP between 2017 and 2021 at the University Hospital of Würzburg. Data of the pre- and postoperative polygraphy, findings of the preoperative awake endoscopy and DISE, choice of surgical therapy and the surgical success according to SHER criteria were evaluated.

Results Mean BMI was at 29.1, the mean tonsil grade was 2.8, and the Mallampati score was 2.2. DISE showed complete lateral collapse in the oropharynx in all patients. Tonsillectomy was performed in all cases. 9 patients additionally received (uvulo-)palatopharyngoplasty. The overall AHI was reduced by an average of 80%. In all patients a surgical success according to the SHER criteria could be achieved.

Discussion DISE complementary to awake endoscopy can improve patient selection and prediction of therapy response. In this case series, OSA was successfully treated in all cases by TE with/without UPPP.

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Artikel online veröffentlicht:
24. Mai 2022