Laurence Gibbs



The closer examination of the study of sleep-disordered breathing (apnea / hypopnea / snoring) is the"sleep endoscopy." The "sleep endoscopy" is performed after the anesthesiologist has induced sleep with adequate doses of short-acting drug(midazolam). Initially you run a fibro endoscopy in vigil with the patient supine to allow viewing of high aero digestive tract; at this point the anesthetist induces sleep in the patient and run a new fibro endoscopy that allows to re-evaluate the objectivity previously observed, any sites of obstruction (nasal, nasopharyngeal, palate, oropharynx, hypopharynx, andlarynx) and the mechanisms that determine the respiratory disorder detected.For the execution of the DISE (Drug Induced Sleep Endoscopy) is essential to use a device (BIS) that finding an electroencephalographic trace on a numerical scale, allows the anesthetist to control and maintain, with appropriate doses of medication, the proper depth of sleep induced.

It is also noted that in the course of the endoscopy will perform a series of maneuvers designed to complete the evaluation of the patient in the course of respiratory events,such as check the progress of the jaw affects breathing ("mandibular pull-up") or as the lateral position during sleep best respiratory dynamics. At this point, the endoscopy physician will complete a form which will describe the level of obstruction and manner of presentation of the same obstructive pattern. This procedure follows the procedures used in the staging of tumors TNM that in the specific case of the DISE is defined grading NOHL where N isthe nose, O the oropharynx, H the hypopharynx and L the larynx; for each of these sites will define the degree (1 to 4) and the methods of obstruction(circular, anterior-posterior and lateral). The Sleep endoscopy to date is the only diagnostic test that allows to evaluate the airway during snoring orepisodes of apnea / hypopnea, significantly reducing the margin of error of patient's therapy.

Therefore the purposeof the DISE can be summarized as follows:

• Differential diagnosis between normal patients and patients with DRS (SDB).

• Mouse-diagnosis ofsites of obstruction.

• Evaluation of theeffect of the maneuver of mandibular advancement (predictive value for theapplication of Oral Appliance) and the lateral positioning.

• Reassessment ofpatients previously treated with surgery and / or insufficient compliance withthe C-PAP.

• Calibration of theC-PAP.

Preliminary considerations for surgery for snoring and sleep apnea syndrome (OSAS)

1. The purpose of alltreatment of snoring is that of its reduction or elimination; The purpose ofthe therapy of OSAS symptom reduction (pauses in breathing or apnea, chokingnight, etc.), the control of excessive daytime sleepiness, the prevention ofcomplications (hypertension, myocardial infarction, arrhythmias, stroke,seizures, road accidents or at work, premature death, depressed or irritablemood, memory disorders).Consult

2. The surgery,especially of the palate, is the measure of first choice for the snoring, withsuccess rates from 50 to 90%. However, there are cases unchanged and sporadic casesof deterioration.

3. For OSAS the onlymeasure with 100% of success is the use of NCPAP ("Night Pump "), butis not accepted or is abandoned by a negligible share of patients.

4. Weight loss,however, fundamental in combination with other therapies, is hardly conclusiveby itself and often is not maintained over time.

5. The so-called"oral devices" (braces similar to those of children) are directed tospecial cases.

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