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Can drug-induced sleep endoscopy improve the success rates of tongue base surgery?

Authors
 Jong-Gyun Ha  ;  Youngwoo Lee  ;  Jae Sung Nam  ;  Jeong Jin Park  ;  Joo-Heon Yoon  ;  Chang-Hoon Kim  ;  Hyung-Ju Cho 
Citation
 JOURNAL OF OTOLARYNGOLOGY-HEAD & NECK SURGERY, Vol.49(1) : e8, 2020 
Journal Title
 JOURNAL OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 
ISSN
 1916-0208 
Issue Date
2020
Keywords
Drug-induced sleep endoscopy ; Muller maneuver ; Obstructive sleep apnea ; Tongue base surgery
Abstract
BACKGROUND: The purpose of this study was to determine the therapeutic value of drug-induced sleep endoscopy (DISE) by comparing the outcomes of tongue base surgery based on Muller's maneuver (MM) and those based on DISE in obstructive sleep apnea (OSA) patients. METHODS: Ninety-five patients who underwent the tongue base surgery in combination with palatal surgery for OSA at a tertiary referral hospital between March 2012 and March 2019 were enrolled in this retrospective comparative study. Forty-seven patients underwent MM for surgical decision and 48 patients underwent DISE in addition to MM for surgical decision. Surgical success was defined according to the Sher criteria (postoperative apnea-hypopnea index [AHI] < 20/h and ≥ 50% reduction in preoperative AHI), and AHI improvement (%) was defined as (preoperative AHI-postoperative AHI) × 100/preoperative AHI. For comparison between the MM and DISE groups, p-values were calculated using independent or paired t-tests for continuous variables and using chi-square test for categorical variables. RESULTS: By comparing the results of MM and DISE, consensus on the tongue base level showed insignificant concordance (kappa = 0.017, p = 0.865), whereas that on the oropharynx level showed fair agreement (kappa =0.241, p = 0.005). AHI, supine AHI, rapid eyeball movement (REM) AHI, non-REM AHI, and nadir oxygen saturation were all significantly improved after the tongue base surgery in both groups. The MM group showed a significant improvement in the Epworth sleepiness scale after the tongue base surgery (p = 0.014), whereas the DISE group did not (p = 0.165). However, there was no significant difference in the AHI improvement (MM group = 47.0 ± 32.0, DISE group = 48.3 ± 35.4, p = 0.852) and surgical success (MM group = 42.6%, DISE group = 45.8%, p = 0.748) between the groups. Tonsil grade (p < 0.05) and occlusion at the oropharynx lateral wall (p = 0.031) were significantly related to surgical success in the MM group. CONCLUSIONS: In the judgment of the tongue base surgery, MM and DISE findings showed poor agreement. DISE might affect the surgical decision on the tongue base surgery in OSA patients; however, there was a lack of evidence regarding the superiority of DISE over MM with respect to the surgical outcomes.
Files in This Item:
T202000801.pdf Download
DOI
10.1186/s40463-020-00405-w
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Chang Hoon(김창훈) ORCID logo https://orcid.org/0000-0003-1238-6396
Nam, Jae Sung(남재성)
Yoon, Joo Heon(윤주헌)
Cho, Hyung Ju(조형주) ORCID logo https://orcid.org/0000-0002-2851-3225
Ha, Jong Gyun(하종균) ORCID logo https://orcid.org/0000-0002-2712-1297
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175595
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