Drug-Induced Sleep Endoscopy (DISE): Phenotyping Obstruction Patterns
University of Pennsylvania
Summary
Drug-induced sleep endoscopy (DISE) represents an opportunity to evaluate the upper airway in sleep-like conditions. In its current clinical form, however, DISE does not routinely determine the functional impact of anatomic and neuromuscular factors on airflow obstruction. The investigators will apply nasal pressure (CPAP) during DISE to generate pressure-flow and pressure-area relationships, deriving functional determinants of upper airway obstruction during sleep. In addition, they will use objective anatomic measurements from computerized tomography (CT) and submental ultrasound. The findings will allow the investigators to streamline the upper airway exam during DISE, and will further the goal of developing personalized solutions that address specific pathogenic mechanisms of pharyngeal collapse and airflow obstruction during sleep. The investigators will use the physiologic and anatomic features derived from DISE and imaging to determine which are predictive of success to standard-of-care surgical interventions (e.g. skeletal, soft tissue, neurostimulation) .
Description
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction due to inadequate muscle tone during sleep leading to nocturnal hypercapnia, repeated oxyhemoglobin desaturations and arousals. Continuous positive airway pressure (CPAP) is the therapeutic mainstay for OSA, but adherence remains poor. Currently, there exist 3 classes of surgical therapy for OSA, each addressing a specific pathologic structure: skeletal surgery (target: jaw bones), neurostimulation (target: tongue), and soft tissue (target: soft palate). Unfortunately, there is a critical knowledge gap in ter…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. Adults (≥ 18yrs) willing and capable of providing informed consent. 2. English-speaking \& able to give Informed Consent. 3. Referred or scheduled for clinically indicated DISE procedure. 4. Seeking CPAP alternatives for treatment of sleep disordered breathing. Exclusion Criteria: * None
Interventions
- OtherPharyngeal Manometry
Catheters will be passed into the nose and advanced to the pharynx to measure airway pressures during drug-induced sleep.
- OtherSubmental Ultrasound
Ultrasound of airway soft tissues
Location
- University of PennsylvaniaPhiladelphia, Pennsylvania