Sleep Testing

Question 1

What are the Indications for Drug-Induced Sleep Endoscopy (DISE)?

Answer 1

1) Home sleep apnea testing or polysomnograpy (PSG) must be performed before DISE
2) DISE is performed as a diagnostic tool for patients with:
- Habitual snoring
- Pts with OSAS when surgery or mandibular advancement therapy (MAD = mandibular advancement device) is being considered as a treatment option
3) DISE can be used to improve understanding the anatomic basis for surgical, MAD, or CPAP failure to help evaluate for additional medical or surgical treatment alternatives
4) DISE is not necessary if CPAP, Weight loss, or positional therapy is being considered

Question 2

What are the Contraindications for DISE?

Answer 2

1) Patients with high ASA (American Society of Anesthesiologists) score
2) Patients with Propofol or Versed allergies
3) Patient’s with severe OSAS and severe obesity are contraindicated because of poor treatment success in these patients

Question 3

What are physical/morphologic Predictors of Obstructive Sleep Apnea?

Answer 3

1) Obesity
2) Neck Size
- Males > 17”
- Females > 16”
3) Maxillary and mandibular deficiency
4) Low hyoid bone
5) Cervical scoliosis
6) Telescoping of mucosa
7) Rugae of posterior pharyngeal wall
8) Lateral pharyngeal wall hypertrophy
9) Malampatti 3/4

Question 4

Physical Exam Findings c/w Obstructive Sleep Apnea

Answer 4

1) Tonsil hypertrophy
2) Major nasal pathology
3) Maxillo-facial deformity (anterior-posterior and width)
4) Oropharynx
- Lateral rugae
- Tongue scalloping from teeth

Question 5

Cricomandibular Perpendicular - what is this?

Answer 5

1) From the lateral view of the patient’s neck, draw a line from the chin to the cricoid. Then, draw a perpendicular line to the cervical mental angle.
- If the perpendicular is > 1.5cm, there is no apnea
- If the perpendicular is < 0cm + apnea
2) The cricomental perpendicular like incorporates several features:
- Central obesity (neck size)
- Retrognathia
- Low hyoid (airway length)
- Cervical posturing

Question 6

Fujita Classification/Mueller’s Maneuver - do these correlate with sleep apnea?

Answer 6

1) They provide minimal insight into the airway
2) Associate, but poorly correlate with outcomes
3) Negative predictor

Question 7

What are surgical predictors of success for OSA surgery?

Answer 7

1) Patient’s with a high AHI and low oxygen saturations are not good surgical candidates
2) Low oxygen saturations indicate unstable physiology
3) Patient’s with CPAP pressures of < 8cm H20 do better with surgery