How is sleep endoscopy performed?

Updated: Aug 21, 2019
  • Author: Philip E Zapanta, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Once the AV tower and FFL are ready, signal the anesthesiologist to begin the propofol infusion. The anesthesiologist must carefully titrate the propofol infusion in order to cause obstructive apnea, but no central apnea. This can easily be observed.

When the patient can no longer be aroused by voice, defog the FFL and introduce it into the nasal cavity. Fully examine the nasal cavity for any airway obstructions and then advance into the nasopharynx. Wait in the nasopharynx until the patient begins snoring.

Examine the nasopharynx, velopharynx, and hypopharynx. Pay attention to the degree of collapse; the following grading scale can be used:

  • 0-25% collapse

  • 26-50% collapse

  • 51-75% collapse

  • 76-100% collapse

Pay attention to the following structures:

  • Obstruction at the level of the palate - Palate, tonsils, and lateral pharyngeal wall

  • Obstruction at the level of the hypopharynx - Base of tongue, epiglottis, and lateral pharyngeal wall (one study mentions that 23% of patients had epiglottic collapse that was not seen on awake endoscopy [24] )

Advance the mandible 5-10 mm forward to reproduce the action of a genioglossal advancement or mandibular advancement device.

Perform a jaw thrust maneuver or insert a nasal trumpet or oral airway to convince oneself or the anesthesiologist of the effectiveness of these simple procedures, which can establish an airway in an obstructing patient.

If there is suspicion preoperatively of hypopharyngeal collapse, one can elect to dissect down to the hyoid bone. During direct visualization of the hypopharynx in DISE, the hyoid bone can be manipulated to simulate hyoid suspension or advancement. If there is improvement in the hypopharyngeal airway during manipulation, the appropriate procedure can be performed (hyoid suspension, myotomy, hyoid advancement, etc).


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