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 Table of Contents  
EDITORIAL
Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 107-108

What's new in the diagnosis and management of obstructive sleep apnoea?


Head of Department of Pulmonary Medicine, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Submission06-Jan-2020
Date of Acceptance17-Jan-2020
Date of Web Publication30-Jan-2020

Correspondence Address:
Prof. Rahul Magazine
Head of Department of Pulmonary Medicine, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ARWY.ARWY_2_20

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How to cite this article:
Magazine R. What's new in the diagnosis and management of obstructive sleep apnoea?. Airway 2019;2:107-8

How to cite this URL:
Magazine R. What's new in the diagnosis and management of obstructive sleep apnoea?. Airway [serial online] 2019 [cited 2020 Feb 21];2:107-8. Available from: http://www.arwy.org/text.asp?2019/2/3/107/277321



Obstructive sleep apnoea (OSA) is a medical syndrome encountered across all age groups. It is characterised by repeated episodes of partial or complete upper airway obstruction, resulting in disturbed sleep. Sleep deprivation affects various body systems, leading to side effects that not only affect quality of life but may also sometimes contribute to mortality. As our understanding of the condition improves, a multidisciplinary approach is needed not only to diagnose the disorder and its repercussions on various body systems but also to plan appropriate management strategies for its treatment.

Pulmonologists, Sleep Medicine specialists and Respiratory Therapists were primarily involved until a few decades ago in the use of non-invasive ventilators for providing continuous positive airway pressure (CPAP) or biphasic positive airway pressure (BiPAP) to overcome sleep-disordered breathing. Anaesthesiologists now assist Otorhinolaryngologists in identifying the exact cause/site of airway obstruction during drug-induced sleep endoscopy (DISE).


  Pulmonology and Sleep Medicine Perspective Top


DISE is gaining increasing attention as a method to ascertain the site, degree and dynamic characteristics of upper airway obstruction during sleep in patients with OSA.[1] Preoperative routine evaluation of the airways in a patient of OSA has been found to be grossly inadequate when compared to the kind of accurate information that can be obtained by DISE.[2] CPAP and BiPAP are no doubt the gold standard for the treatment of OSA. However, if surgical management is planned for a few selected patients, then DISE can influence the correct surgical strategy to be adopted. Surgical plan can change post-DISE in 60.8% of the patients.[2]

The findings of preoperative DISE in patients with OSA could potentially help the surgeon anticipate therapeutic response to surgeries such as tonsillectomy, uvulopalatopharyngoplasty or a combination of the two, done for the treatment of OSA.[3]

In the study published in this issue of Airway, Kukreja et al. highlight the role of DISE in identifying the site of upper airway obstruction in OSA patients. The authors have emphasised the role of DISE in planning a better and perhaps safer anaesthetic for surgeries in such patients, keeping in mind the sensitivity of these patients to the respiratory depressant action of various sedatives.[4] If DISE has to get much wider acceptance, more focussed randomised controlled trials need to be conducted. Thus, for the purpose of research, and also for ease in clinical practice, a standardised classification for capture of data regarding the sites of obstruction needs to be developed.[5]

Positional awake endoscopy is another technique for the evaluation of upper airway dynamics in OSA patients and has been shown to be comparable to DISE by some authors.[6]


  Dental Perspective Top


Paedodontists and Orthodontists play an important role in the early diagnosis and conservative management of OSA using dental appliances. Oral Appliance Therapy (OAT) has provided another treatment option to patients with OSA before a decision is taken by the Otorhinolaryngologist or the Maxillofacial Surgeon to perform corrective surgery.

The extensive review of OAT devices by Ravindar et al. in this issue of Airway emphasises the next logical step in the management of OSA. The article compares the merits and demerits of factory-made OAT devices versus custom-made devices by the Orthodontist. The important role of the Paedodontist in early identification of the potential to develop OSA in adulthood emphasises how preventive dentistry can help to interrupt the progress of this condition before it becomes medically significant.[7]

These two articles in this issue of Airway have opened our eyes to the exciting options emerging in the horizon related to the diagnosis and management of OSA.[4],[7] The day is not far when meticulous application of treatment options based on more specific diagnostic tests will reduce morbidity and mortality related to OSA.



 
  References Top

1.
Eggerstedt M, Urban MJ, Chi E, Ritz EM, Losavio P. The anesthesia airway evaluation: Correlation with sleep endoscopy findings. Am J Otolaryngol 2019:102362. doi: 10.1016/j.amjoto.2019.102362. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0196070919309329?via%3Dihub. [Last accessed on 2020 Jan 06].  Back to cited text no. 1
    
2.
Hybášková J, Jor O, Novák V, Zeleník K, Matoušek P, Komínek P. Druginduced sleep endoscopy changes the treatment concept in patients with obstructive sleep apnoea. Biomed Res Int 2016;2016:6583216. doi: 10.1155/2016/6583216. Available from: https://new.hindawi.com/journals/bmri/2016/6583216/. [Last accessed on 2020 Jan 06].  Back to cited text no. 2
    
3.
Wang Y, Sun C, Cui X, Guo Y, Wang Q, Liang H. The role of drug-induced sleep endoscopy: Predicting and guiding upper airway surgery for adult OSA patients. Sleep Breath 2018;22:925-31.  Back to cited text no. 3
    
4.
Kukreja A, Shenkar A, Satish K, Kotekar N. Anaesthesiologists' role in diagnostic drug-induced sleep endoscopy and subsequent management strategy planning in obstructive sleep apnoea syndrome. Airway 2019;2:135-41.  Back to cited text no. 4
  [Full text]  
5.
Albdah AA, Alkusayer MM, Al-Kadi M, Almofada H, Alnofal EA, Almutairi S. The impact of drug-induced sleep endoscopy on therapeutic decisions in obstructive sleep apnea: A systematic review and meta-analysis. Cureus 2019;11:e6041.  Back to cited text no. 5
    
6.
Askar SM, Quriba AS, Hassan EM, Awad AM. Positional awake endoscopy versus DISE in assessment of OSA: A comparative study. Laryngoscope 2019. doi: 10.1002/lary.28391. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/lary.28391. [Last accessed on 2020 Jan 06].  Back to cited text no. 6
    
7.
Ravindar P, Balaji K, Saikiran KV, Srilekha A, Alekhya K. Oral appliances in the management of obstructive sleep apnoea syndrome. Airway 2019;2:109-19.  Back to cited text no. 7
  [Full text]  




 

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