|Year : 2019 | Volume
| 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 Submission||06-Jan-2020|
|Date of Acceptance||17-Jan-2020|
|Date of Web Publication||30-Jan-2020|
Prof. Rahul Magazine
Head of Department of Pulmonary Medicine, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal - 576 104, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Magazine R. What's new in the diagnosis and management of obstructive sleep apnoea?. Airway 2019;2:107-8
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|| |
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. 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. 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.
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.
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. 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.
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.
| Dental Perspective|| |
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.
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., 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|| |
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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. [Full text]
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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. [Full text]