Jalil, Suhaili Abdul
(2016)
Comparative study of muller's maneuver and dexmedetomidine-induced sleep endoscopy in snoring adults.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction
Sleep-disordered breathing (SDB) comprises a wide spectrum of sleep-related breathing
abnormalities from simple snorer at the one end and obstructive sleep apnoea/hypopnea
syndrome (OSAHS) at the other end. It is characterized by repetitive partial or complete
collapse of the upper airway during sleep, resulting in intermittent cessations of
breathing (apnoeas) and reduction in airflow (hypopneas) despite on-going respiratory
effort. Flexible nasopharyngolaryngoscope (FNPLS) can identify and quantify the site
and degree of obstruction that caused the snoring. However, we normally evaluate the
patient when he or she is awake and in erect position, whereas snoring occurs when
patient is in supine and sleeping. The endoscopic findings during awake endoscopy may
not accurate to conclude the site responsible for the production of snoring. Sleep
endoscopy in the naturally asleep patient is a diagnostic method permits the examiner to
better determine the site that is responsible for the production of snoring. The drug used
is Dexmedetomidine with or without Midazolam. This can be beneficial for the choice
of the different and most appropriate treatment options for optimal benefits to the
patients.
Objective
To compare awake endoscopy (Muller’s maneuver) and drug-induced sleep endoscopy
(DISE) findings in snoring individuals.Study design
A cross sectional study was performed on patients aged more than 18 years old, with
symptom of snoring planned for elective adenotonsillectomy and able to co-operate for
FNPLS examination in Hospital Universiti Sains Malaysia.
Methodology
The consented patients who fulfilled the criterias were subjected to FNPLS with
Muller’s maneuver at ORL-HNS Clinic, HUSM. After that, patients were admitted to
ward one day prior to elective adenotonsillectomy surgery. Pre-operative assessment
was done to assess whether patients were suitable and safe for Dexmedetomidineinduced
sleep endoscopy. Patients were induced with the drug prior to intubation.
FNPLS was repeated once patients reached sleep state based on bispectral index scoring
system (BISS) score.
Result
A total of 15 patients with symptom of snoring participated in this study. Sixty-seven
percent of them are male. All patients showed only one level airway obstruction which
is at retropalatal level. Sixty percent have concentric type and 40% have lateral type of
airway obstruction during Muller’s maneuver and during DISE, the configuration of
airway obstruction was 80% and 20% respectively. During Muller’s maneuver, only
33% of patients showed grade 1 (50-75%) of airway obstruction and 67% showed grade
0 (<50%) at retropalatal level. However, during DISE, 67% and 33% of patients showed
grade 1 and grade 2 (>75%) of airway obstruction respectively. All patients showedgrade 0 at retrolingual level during both procedures. Our study showed that there was
poor agreement between Muller’s maneuver and DISE according to its degree and
configuration of airway obstruction with ICC value was 0.14. Twenty percent of
patients showed changes in the configuration of airway obstruction.
Conclusion
The degree of airway obstruction during DISE was more severe compared with the
Muller’s maneuver. There was different in configuration of airway obstruction observed
between these 2 procedures. DISE permits better evaluation of the degree and level of
airway obstruction.
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