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      Endoscopia del sueño mediante sedación inducida por fármacos o somnoscopia Translated title: Drug inducted sleep endoscopy or somnoscopy

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          Abstract

          RESUMEN Introducción y objetivos: Somnoscopy can Valore the possible obstruction in superior aerodigestive tract, that lead to obstructive sleep apnea syndrome (OSAS). Our objective is showing our experience using the somnoscopy or DISE (drug induced sleep endoscopy). Material y métodos: Presentamos un estudio retrospectivo de 17 pacientes de los que se excluyen finalmente 2. La edad de los pacientes varió de 34 a 72 años. Se practica polisomnografía previa y el IAH medio fue 7,32±8,71. Discusión y conclusión: La DISE es una técnica segura, reproducible y aplicable en cualquier servicio de ORL. Así mismo, permite individualizar el tratamiento quirúrgico y probablemente evitar cirugías innecesarias.

          Translated abstract

          ABSTRACT Introduction and objectives: The diagnostic test of COVID-19 with the highest sensitivity is a nasopharyngeal sample using a swab for subsequent study using RT-PCR. The objective of our work is to explain in detail the most appropriate way to perform this technique. Material and methods: We present a retrospective study of 17 patients. Finally, two patients were excluded. The patients were 34-72 years old. A Polysomnography was done, and hypopneaapnea index was 7,32±8,71. Discussion and conclusions: This a secure technique and can be reproduced in all ENT services. DISE less us individualize chirurgical treatment and avoid us unnecessary patients' operations.

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          Most cited references12

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          The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome.

          This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The intent of this paper is to provide an overview of the surgical treatment of obstructive sleep apnea syndrome, to provide the basis for the American Sleep Disorders Association's practice parameters on this subject and to share our findings of metanalysis of previously published studies regarding uvulopalatopharyngoplasty. We searched MEDLINE from January 1966 through April 1993, with an update in February 1995, to provide a review of the application of surgical modifications of the upper airway to treat adults with obstructive sleep apnea syndrome. Operations to treat obstructive sleep apnea syndrome include nasal septal reconstruction; uvulopalatopharyngoplasty; uvulopalatopharyngoglossoplasty; laser midline glossectomy; lingualplasty; inferior sagittal mandibular osteotomy and genioglossal advancement, with hyoid myotomy and suspension (the entire process is referred to as GAHM); maxillomandibular osteotomy and advancement, and tracheotomy. Papers included in metanalysis provided preoperative and postoperative polysomnographic data on at least nine patients treated with uvulopalatopharyngoplasty for their obstructive sleep apnea. Analysis of the uvulopalatopharyngoplasty papers revealed that this procedure is, at best, effective in treating less than 50% of patients with obstructive sleep apnea syndrome. The site of pharyngeal narrowing or collapse, although identified by different and unvalidated methods, has a marked effect on the probability of success of uvulopalatopharyngoplasty. Patients who achieve a favorable response with uvulopalatopharyngoplasty tend to have less severe obstructive sleep apnea than those who do not. For patients who demonstrate retrolingual narrowing or collapse, other surgical modifications have been described, such as lingualplasty, GAHM, and maxillomandibular osteotomy and advancement. The studies to support the use of the surgical treatment of obstructive sleep apnea syndrome contain biases related to small sample size, limited follow-up and patient selection.
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            Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea.

            It appears that uvulopalatopharyngoplasty (UVPP) is a reliable procedure for reducing snoring, but much less reliable when used as a treatment for OSAS. This is thought to be because of poor patient selection in that the site of the problem is not always the site of the operation. We present the technique of sleep nasendoscopy which allows direct visualization of the site or sites of obstruction in a sleeping patient. Our study has shown that there are patients with obstructive sleep apnoea syndrome (OSAS) in whom the only site of pharyngeal obstruction is at the velopharynx. These patients should do well with the relatively simple procedure of UVPP. This is not true for many other OSAS patients in whom we found that obstruction was multisegmental. This helps to explain the frequently poor results of UVPP in OSAS patients. We feel that this form of preoperative assessment will avoid unnecessary surgery.
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              Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofol.

              Upper airway collapsibility is known to increase under anesthesia. This study assessed how this increase in collapsibility evolves during slow Propofol induction and how it relates to anesthesia-induced changes in upper airway muscle activity and conscious state. Nine healthy volunteers were studied. Anesthesia was induced with Propofol in a step-wise manner (effect-site concentration steps of 0.5 microg x ml(-1) from 0 to 3 microg x ml(-1) and thereafter to 4 microg x ml(-1) and 6 microg x ml(-1) [target-controlled infusion]). Airway patency was maintained with continuous positive airway pressure. Pharyngeal collapsibility was assessed at each concentration by measuring critical pressure. Intramuscular genioglossus electromyogram and anesthetic depth (bispectral index score) were monitored throughout. Loss of consciousness was defined as failure to respond to loud verbal command. Loss of consciousness occurred at varying Propofol effect-site concentrations between 1.5 and 4.0 microg x ml(-1). Initially genioglossus electromyographic activity was sustained with increases in Propofol concentration, increasing in some individuals. At or approaching loss of consciousness, it decreased, often abruptly, to minimal values with an accompanying increase in critical pressure. In most subjects, bispectral index score decreased alinearly with increasing Propofol concentration with greatest rate of change coinciding with loss of consciousness. Slow stepwise induction of Propofol anesthesia is associated with an alinear increase in upper airway collapsibility. Disproportionate decreases in genioglossus electromyogram activity and increases in pharyngeal critical closing pressure were observed proximate to loss of consciousness, suggesting that particular vulnerability exists after transition from conscious to unconscious sedation. Such changes may have parallels with upper airway behavior at sleep onset.
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                December 2020
                : 11
                : 4
                : 395-400
                Affiliations
                [1] Ávila orgnameComplejo Asistencial de Ávila orgdiv1Servicio de Otorrinolaringología España
                [2] Ávila orgnameComplejo Asistencial de Ávila orgdiv1Servicio de Anestesiología España
                Article
                S2444-79862020000400002 S2444-7986(20)01100400002
                4e883c72-508e-4276-9840-cbcdeee22f48

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 12 January 2020
                : 01 March 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 6
                Product

                SciELO Spain

                Categories
                Artículo original

                DISE,somnoscopia,somnoscopy,Obstructive sleep apnea syndrome,Síndrome de apnea obstructiva del sueño

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