The Impact of Drug-induced Sleep Endoscopy on Therapeutic Decisions in Obstructive Sleep Apnea: A Systematic Review and Meta-analysis
| Autor: | Mohammed Al-Kadi, Meshael M Alkusayer, Sara G. Almutairi, Hesham Almofada, Abdullah A Albdah, Ebraheem A Alnofal |
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| Rok vydání: | 2019 |
| Předmět: |
Müller's maneuver
medicine.medical_specialty medicine.medical_treatment Subgroup analysis 030204 cardiovascular system & hematology 03 medical and health sciences Otolaryngology 0302 clinical medicine Internal medicine medicine obstructive sleep apnea sleep disorder Sleep disorder business.industry General Engineering medicine.disease Confidence interval Obstructive sleep apnea drug-induced sleep endoscopy Meta-analysis Midazolam Public Health business Propofol 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Cureus |
| ISSN: | 2168-8184 |
| Popis: | Objective The aim of this study was to assess the ability of drug-induced sleep endoscopy (DISE) to change therapeutic decisions through the identification of obstruction sites in patients with obstructive sleep apnea (OSA). Materials and methods A systematic review and meta-analysis were conducted concerning studies that reported the impact of DISE on therapeutic recommendations. The percentage of change was collected for each study and per site of the collapse. The pooled rate of change and the respective 95% confidence interval (CI) were computed. Subgroup analysis was performed based on patients’ age, sample size, the applied DISE protocol, and the originally used diagnostic modality before DISE. Results In a total of nine studies, 1247 patients were included (69.2% males, 59.7% children, 78.04% with a multilevel collapse). Therapeutic decisions changed in 43.69% of patients (CI, 33.84 to 53.54). The change rates were significantly higher in adults (54.0% versus 25.9% in children, P = 0.001), midazolam-based DISE protocols (78.4% versus 48.45% for midazolam plus propofol and 33.9% for propofol, P < 0.001), and after awake endoscopy (62.2% as compared to 44.6% after clinical basic examination [CBE], 40.1% after CBE, lateral cephalometry, and Muller maneuver, P = 0.02). Changes at uvular and palatal sites were more frequent in adults and at the tonsils in children. Conclusion The DISE approach can be promoted via implementing unified classification systems of obstruction sites; the widescale application of target-controlled infusion and its therapeutic benefits can be explored in well-designed randomized studies that compare its efficacy with other diagnostic modalities. |
| Databáze: | OpenAIRE |
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