Analysis of upper airway obstruction in patients with OSA by fiber endoscopy in drug induced sleep(DISE)

Ciljevi istraživanja: Ispitati lokalizacije, stupnjeve i oblike opstrukcije OSA-e u gornjem dišnom sustavu putem DISE prema VOTE klasifikaciji i njihovu povezanost s težinom bolesti koja je izražena AHI-em. Nacrt studije: Presječna studija Materijal i metode: Analizirani su zapisi iz medicinske dokumentacije,zapisi i video snimke 30 DISE u poziciji ležanja pacijenta na leđima da bih utvrdio mjesta i stupanj opstrukcije gornjega dišnoga sustava po VOTE klasifikaciji zbog kojih nastaje OSA. Osim toga, iz dostupne medicinske dokumentacije prikupljeni su podatci o dobu, spolu, AHI indeksu tijekom DISE. Ako su dvije skupine, koristio se Studentov t-test, a između više skupina koristila se ANOVA. U slučaju da podatci ne slijede normalnu distribuciju, koristio se Kruskal–Wallis test. Rezultati: Žene u isptivanju su bile u prosjeku starije od muškaraca. Muškarci imaju veći medijan AHI nego žene. Najviše pacijenata ima opstrukciju bilo djelomično, bilo potpunu na lokalizaciji retropalatuma. Potpunu opstrukciju najviše pacijenata ima na lokalizaciji orofarinksa (53,3 %). Značajno najviše bolesnika bilo je bez opstrukcije baze jezika (83,3%). Opstrukciju epiglotisa imalo je ukupno 17/30 bolesnika. Najviši AHI zabilježen u skupini bolesnika s ukupno četiri mjesta opstrukcije, a najniži AHI u skupini bolesnika s jednim mjestom opstrukcije. Zaključak: Najčešće mjesto opstrukcije jest retropalatum. Najčešće mjesto potpune opstrukcije jest orofarinks. Bolesnici s opstrukcijom epiglotisa su značajno stariji od bolesnika bez opstrukcije epiglotisa. Bolesnici stariji od 65 godina imaju veći AHI nego skupina bolesnika mlađih od 65.OBJECTIVES: The aim of this research was to analyse localization, stages and forms of OSA obstruction in the upper respiratory system via DISE according to VOTE classification and their association with the severity of the disease expressed by AHI. STUDY OUTLINE: Cross-sectional study MATERIALS AND METHODS: Medical records, records and video recordings of 30 fiberendoscopies were analysed during pharmacologically induced sleep in patients while lying on back to determine the location and degree of the obstruction of the upper respiratory tract by VOTE classification, which causes obstructive sleep apnea. In addition, from available medical documentation we collected data on age, sex, and AHI index data during DISE. RESULTS: Women in this study were on average older than men. Men have a higher median AHI than women. Most patients have either partial or complete obstruction of retropalatum (86.7 %). The most patients have complete obstruction of oropharynx (53.3 %). Significantly the highest number of patients was without the obstruction of the tongue base (83.3 %). A total of 17 (56.7 %) patients had the epiglottis obstruction, of which 5 (16.7 %) were partial and 12 (40 %) were complete. The highest AHI was found in group of patients with a total of four obstruction sites, and the lowest AHI in a single obstruction patient group. CONCLUSION: The most common obstruction site (including stage 1 and 2) is the retropalatum. The most common place of complete obstruction is oropharynx. Patients with epiglottis obstruction are older than patients with no obstruction of epiglottis. Patients older than 65 years have higher AHI than patients under the age of 65