Drug induced sleep endoscopy: its role in evaluation of the upper airway obstruction and patient selection for surgical and nonsurgical treatment
Drug induced sleep endoscopy: its role in evaluation of the upper airway obstruction and patient selection for surgical and nonsurgical treatment
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DOI：
10.21037/jtd.2017.10.32
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发表时间：
2018-01-01
影响因子：
2.5
通讯作者：
De Vito, Andrea
中科院分区：
文献类型：
--
作者：
Kotecha, Bhik;De Vito, Andrea
睡眠相关的呼吸障碍会导致上呼吸道阻塞，可以通过持续气道正压通气 (CPAP) 治疗、口腔装置或手术干预来缓解。非手术治疗方式并不总是被患者接受，为了获得成功的手术结果，有必要对上呼吸道进行评估，以仔细选择可以从手术中受益的患者。有多种技术可用于评估上呼吸道阻塞，包括成像、声学分析、压力传感器记录和内窥镜评估。值得注意的是，与清醒时上呼吸道管腔的张力相比，夜间阻塞性上呼吸道的肌肉控制有限。因此，如果试图找出导致睡眠相关呼吸障碍上气道阻塞的解剖部位；必须记住，如果可能的话，必须在患者清醒和睡着的情况下进行气道评估，尽管是在药物诱导的睡眠期间。这一事实本身限制了成像技术的使用。药物诱导睡眠内窥镜检查 (DISE) 于 1990 年在伦敦皇家国家喉鼻耳医院首创，最初被称为睡眠鼻内窥镜检查。各机构已对术语和技术进行了修改，但该评估技术的核心价值仍然相似，并且对于识别睡眠相关呼吸障碍患者睡眠期间阻塞上呼吸道的解剖部分非常有用。围绕该技术存在许多争议，但在过去的二十年中，大多数争议已经得到解决，并且现在仍然处于评估上呼吸道阻塞方法的前沿。已经描述了多种镇静剂和不同的分级系统，并且已经努力统一该技术的各个方面。本文将探讨其用途和优点，并讨论使用 DISE 对上呼吸道评估领域做出的一些重要贡献。
Sleep related breathing disorders cause obstruction of the upper airway which can be alleviated by continuous positive airway pressure (CPAP) therapy, oral devices or surgical intervention. Non-surgical treatment modalities are not always accepted by patients and in order to attain successful surgical outcomes, evaluation of the upper airway is necessary to carefully select the patients who would benefit from surgery. There are numerous techniques available to assess the upper airway obstruction and these include imaging, acoustic analysis, pressure transducer recording and endoscopic evaluation. It is essential to note that the nocturnal obstructive upper airway has limited muscle control compared to the tone of the upper airway lumen during wakefulness. Thus, if one were to attempt to identify the anatomical segments contributing to upper airway obstruction in sleep related breathing disorders; it must be borne in mind that evaluation of the airway must be performed if possible when the patient is awake and asleep albeit during drug induced sleep. This fact as such limits the use of imaging techniques for the purpose. Drug induced sleep endoscopy (DISE) was pioneered at Royal National Throat, Nose and Ear Hospital, London in 1990 and initially introduced as sleep nasendoscopy. The nomenclature and the technique has been modified by various Institutions but the core value of this evaluation technique remains similar and extremely useful for identifying the anatomical segment responsible for obstructing the upper airway during sleep in patients with sleep related breathing disorders. There have been numerous controversies that have surrounded this technique but over the last two decades most of these have been addressed and it now remains in the forefront of methods of evaluating the upper airway obstruction. A variety of sedative agents and different grading systems have been described and efforts to unify various aspects of the technique have been made. This article will look at its usefulness and advantages and will discuss some important contributions made to the field of evaluation of the upper airway using DISE.