Role of drug induced sleep endoscopy in morphological diagnosis with continuous positive airway pressure titration in OSA patients

Abstract Background Continuous positive airway pressure (CPAP) is the most extremely effective treatment for moderate-to-severe OSA. Though, upper airway (UAW) obstruction location identification is a difficult task in order to comprehend the potential mechanism of a high CPAP titration level, which can be achieved through DISE-assisted CPAP titration. To assess the location and pattern of UAW obstruction in OSA cases and to evaluate a novel method of CPAP titration through drug-induced sleep endoscopy (DISE). Method This prospective observational diagnostic study was involved on 30 cases with OSA who involved in the sleep-disordered breathing unit. All cases were divided into 2 equal groups I: OSA moderate cases (15 ≥ apnea-hypopnea index (AHI) < 30 event /h) and groups II: OSA severe cases (AHI of ≥ 30 event/h). All cases underwent history taking, Berlin score, STOP-BANG score and Epworth sleepiness scale (ESS), complete physical examination including anthropometric measures, ECG, ABGs, laboratory investigations and the diagnostic polysomnography and the manual CPAP titration, estimation of the predicted CPAP by four different predictive formulae and then DISE examination with assessment of UAW obstruction by VOTE classification and DISE assisted CPAP titration. Results Regarding group I, the comparison of CPAP titration using all methodologies revealed there were insignificant results between CPAP titration by DISE and other conventional studied methods. Regarding CPAP titration in group II by studied methods, there were insignificant results between CPAP titration by DISE and manual CPAP titration. Cases had velum concentric collapse were related to a significantly increase the CPAP pressure than cases had normal velum and CPAP pressure level measured by DISE. DISE was employed to evaluate a novel method of CPAP titration and to evaluate the location and pattern of UAW obstruction in OSA cases. Conclusions DISE is a dynamic method for visualizing the anatomical sites and patterns of upper airway obstruction. DISE-assisted CPAP titration yielded CPAP pressure requirements comparable to those obtained by standard manual titration, with strong agreement between the paired pressure measurements. The clinical and anatomical findings may help explain individual CPAP pressure requirements and titration failure in selected patients.