KBB-Forum 2015 , Cilt 14, Sayı 2

VIDEOENDOSCOPIC IMAGING OF UPPER AIRWAY OBSTRUCTION CHANGES IN A MILD DEGREE OBSTRUCTIVE SLEEP APNEA PATIENT IN ACCORDANCE WITH NATURAL SLEEP STAGES

Dr. Adin SELÇUK1, Dr. Erkan ESEN2, Dr. Zahide YILMAZ3, Dr. Ferit BAYAKIR4, Dr. Fatih ÖZDOĞAN2, Dr. Halil Erdem ÖZEL2, Dr. Turgut YÜCE2, Dr. Selahattin GENÇ5
1Kocaeli Derince Eğitim ve Araştırma Hastanesi KBB Kliniği, Doç Dr, Klinik Eğitim ve İdari Sorumlusu, Kocaeli, Türkiye
2Kocaeli Derince Eğitim ve Araştırma Hastanesi KBB Kliniği, Uzman Doktor, Kocaeli, Türkiye
3Kocaeli Derince Eğitim ve Araştırma Hastanesi Nöroloji Kliniği, Uyku laboratuvarı sorumlusu, Uzman Doktor, Kocaeli, Türkiye
4Kocaeli Derince Eğitim ve Araştırma Hastanesi KBB Kliniği, Asistan Doktor, Kocaeli, Türkiye
5Kocaeli Derince Eğitim ve Araştırma Hastanesi KBB Kliniği, Doç Dr, Klinik Eğitim Görevlisi, Kocaeli, Türkiye Drug-induced sedation endoscopy (sleep endoscopy) is the most useful method in surgical decision of patients with obstructive sleep apnea. Determination of the site, degree and configuration of the upper airway obstruction by help of sleep endoscopy causes the most appropriate surgical treatment choice and treatment success would be raised.

Although sleep endoscopy mimics most closely the natural sleep physiology, it mostly represents the N2-superficial stage of the sleep, but the main upper airway muscle tone reduction and increased snoring and apnea are shown mostly in REM phase.

In addition, pharyngeal dilator muscle tones are known to be different at REM and non-REM stages.

In this presentation, we obtained natural sleep videoendoscopic recordings during full channel polysomnographic examination in a case with moderate obstructive sleep apnea syndrome, we observed upper airway changes according to the sleep stages, and upper airway obstruction levels, degrees and configuration changes were reviewed.

Natural sleep endoscopy showed similarity in all phases of the sleep in term of location of the obstruction. Therefore, the sedation endoscopy which is similar to N2 sleep may mimic the site of obstruction for a particular phase. However, it was observed that the degree of obstruction was increased and apnea periods were prolonged in the REM stage of sleep. It was also seen that the configuration of the obstruction has changed. Since sedation endoscopy mimics N2-superficial stage of the sleep, it was considered that the pathology may be shown less severe.

A large number of study is needed in order to reach objective results. Keywords : Polysomnography, obstructive sleep apnea, videoendoscopy