Efficacy of Upper Gastrointestinal Endoscopic Examination to Identify Patients with Obstructive Sleep Apnea Syndrome: A Retrospective Cross-Sectional Study
Background/Aims: Despite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS. Methods: After endoscopic evaluation of laryngo-pharyngea...
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| Published in | Digestion Vol. 99; no. 3; pp. 252 - 259 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Basel, Switzerland
01.01.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0012-2823 1421-9867 1421-9867 |
| DOI | 10.1159/000491385 |
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| Abstract | Background/Aims: Despite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS. Methods: After endoscopic evaluation of laryngo-pharyngeal collapse, a total of 154 subjects with laryngo-pharyngeal collapse and 52 control subjects underwent polysomnography. Based on the modified Fujita Classification, upper airway obstruction was classified into 3 different types: oropharyngeal, supraglottic and combined type, and associations between upper airway obstruction and OSAS were evaluated. Results: Of 154 subjects with laryngo-pharyngeal collapse, 108 (70.1%) were diagnosed as OSAS, while only 4 (7.7%) control subjects were diagnosed as OSAS (p < 0.001). The sensitivity and specificity of endoscopic diagnosis were 96.4 and 51.1%, respectively. Oropharyngeal involvement was frequently found in 90.2% of the subjects (139/154). The severity of upper airway obstruction was significantly correlated with the apnea-hypopnea index score (r = 0.55, p < 0.001). A multivariate logistic regression analysis revealed that a male sex (OR 5.20; 95% CI 2.65–10.2, p < 0.001), body mass index ≥25 kg/m 2 (OR 4.98; 95% CI 2.23–11.2, p = 0.02) and severe obstruction (OR 7.79; 95% CI 3.34–18.2, p < 0.001) were significant independent predictors of severe OSAS. Conclusion: A conventional upper GI endoscopic examination might be useful as a diagnostic modality for OSAS. |
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| AbstractList | Despite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS.
After endoscopic evaluation of laryngo-pharyngeal collapse, a total of 154 subjects with laryngo-pharyngeal collapse and 52 control subjects underwent polysomnography. Based on the modified Fujita Classification, upper airway obstruction was classified into 3 different types: oropharyngeal, supraglottic and combined type, and associations between upper airway obstruction and OSAS were evaluated.
Of 154 subjects with laryngo-pharyngeal collapse, 108 (70.1%) were diagnosed as OSAS, while only 4 (7.7%) control subjects were diagnosed as OSAS (p < 0.001). The sensitivity and specificity of endoscopic diagnosis were 96.4 and 51.1%, respectively. Oropharyngeal involvement was frequently found in 90.2% of the subjects (139/154). The severity of upper airway obstruction was significantly correlated with the apnea-hypopnea index score (r = 0.55, p < 0.001). A multivariate logistic regression analysis revealed that a male sex (OR 5.20; 95% CI 2.65-10.2, p < 0.001), body mass index ≥25 kg/m2 (OR 4.98; 95% CI 2.23-11.2, p = 0.02) and severe obstruction (OR 7.79; 95% CI 3.34-18.2, p < 0.001) were significant independent predictors of severe OSAS.
A conventional upper GI endoscopic examination might be useful as a diagnostic modality for OSAS. Despite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS.BACKGROUND/AIMSDespite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS.After endoscopic evaluation of laryngo-pharyngeal collapse, a total of 154 subjects with laryngo-pharyngeal collapse and 52 control subjects underwent polysomnography. Based on the modified Fujita Classification, upper airway obstruction was classified into 3 different types: oropharyngeal, supraglottic and combined type, and associations between upper airway obstruction and OSAS were evaluated.METHODSAfter endoscopic evaluation of laryngo-pharyngeal collapse, a total of 154 subjects with laryngo-pharyngeal collapse and 52 control subjects underwent polysomnography. Based on the modified Fujita Classification, upper airway obstruction was classified into 3 different types: oropharyngeal, supraglottic and combined type, and associations between upper airway obstruction and OSAS were evaluated.Of 154 subjects with laryngo-pharyngeal collapse, 108 (70.1%) were diagnosed as OSAS, while only 4 (7.7%) control subjects were diagnosed as OSAS (p < 0.001). The sensitivity and specificity of endoscopic diagnosis were 96.4 and 51.1%, respectively. Oropharyngeal involvement was frequently found in 90.2% of the subjects (139/154). The severity of upper airway obstruction was significantly correlated with the apnea-hypopnea index score (r = 0.55, p < 0.001). A multivariate logistic regression analysis revealed that a male sex (OR 5.20; 95% CI 2.65-10.2, p < 0.001), body mass index ≥25 kg/m2 (OR 4.98; 95% CI 2.23-11.2, p = 0.02) and severe obstruction (OR 7.79; 95% CI 3.34-18.2, p < 0.001) were significant independent predictors of severe OSAS.RESULTSOf 154 subjects with laryngo-pharyngeal collapse, 108 (70.1%) were diagnosed as OSAS, while only 4 (7.7%) control subjects were diagnosed as OSAS (p < 0.001). The sensitivity and specificity of endoscopic diagnosis were 96.4 and 51.1%, respectively. Oropharyngeal involvement was frequently found in 90.2% of the subjects (139/154). The severity of upper airway obstruction was significantly correlated with the apnea-hypopnea index score (r = 0.55, p < 0.001). A multivariate logistic regression analysis revealed that a male sex (OR 5.20; 95% CI 2.65-10.2, p < 0.001), body mass index ≥25 kg/m2 (OR 4.98; 95% CI 2.23-11.2, p = 0.02) and severe obstruction (OR 7.79; 95% CI 3.34-18.2, p < 0.001) were significant independent predictors of severe OSAS.A conventional upper GI endoscopic examination might be useful as a diagnostic modality for OSAS.CONCLUSIONA conventional upper GI endoscopic examination might be useful as a diagnostic modality for OSAS. Background/Aims: Despite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS. Methods: After endoscopic evaluation of laryngo-pharyngeal collapse, a total of 154 subjects with laryngo-pharyngeal collapse and 52 control subjects underwent polysomnography. Based on the modified Fujita Classification, upper airway obstruction was classified into 3 different types: oropharyngeal, supraglottic and combined type, and associations between upper airway obstruction and OSAS were evaluated. Results: Of 154 subjects with laryngo-pharyngeal collapse, 108 (70.1%) were diagnosed as OSAS, while only 4 (7.7%) control subjects were diagnosed as OSAS (p < 0.001). The sensitivity and specificity of endoscopic diagnosis were 96.4 and 51.1%, respectively. Oropharyngeal involvement was frequently found in 90.2% of the subjects (139/154). The severity of upper airway obstruction was significantly correlated with the apnea-hypopnea index score (r = 0.55, p < 0.001). A multivariate logistic regression analysis revealed that a male sex (OR 5.20; 95% CI 2.65–10.2, p < 0.001), body mass index ≥25 kg/m 2 (OR 4.98; 95% CI 2.23–11.2, p = 0.02) and severe obstruction (OR 7.79; 95% CI 3.34–18.2, p < 0.001) were significant independent predictors of severe OSAS. Conclusion: A conventional upper GI endoscopic examination might be useful as a diagnostic modality for OSAS. Background/Aims: Despite the high prevalence of obstructive sleep apnea syndrome (OSAS), most individuals are unaware of its diagnosis. We assessed whether an upper gastrointestinal (GI) endoscopy can accurately predict the incidence of OSAS. Methods: After endoscopic evaluation of laryngo-pharyngeal collapse, a total of 154 subjects with laryngo-pharyngeal collapse and 52 control subjects underwent polysomnography. Based on the modified Fujita Classification, upper airway obstruction was classified into 3 different types: oropharyngeal, supraglottic and combined type, and associations between upper airway obstruction and OSAS were evaluated. Results: Of 154 subjects with laryngo-pharyngeal collapse, 108 (70.1%) were diagnosed as OSAS, while only 4 (7.7%) control subjects were diagnosed as OSAS (p < 0.001). The sensitivity and specificity of endoscopic diagnosis were 96.4 and 51.1%, respectively. Oropharyngeal involvement was frequently found in 90.2% of the subjects (139/154). The severity of upper airway obstruction was significantly correlated with the apnea-hypopnea index score (r = 0.55, p < 0.001). A multivariate logistic regression analysis revealed that a male sex (OR 5.20; 95% CI 2.65–10.2, p < 0.001), body mass index ≥25 kg/m2 (OR 4.98; 95% CI 2.23–11.2, p = 0.02) and severe obstruction (OR 7.79; 95% CI 3.34–18.2, p < 0.001) were significant independent predictors of severe OSAS. Conclusion: A conventional upper GI endoscopic examination might be useful as a diagnostic modality for OSAS. |
| Author | Nakao, Tomomi Kimoto, Yoshiaki Matsuhashi, Nobuyuki Morinushi, Tatsuo Ueno, Sayaka Sakai, Eiji Nakaji, Shigeyuki Ohata, Ken Konishi, Takafumi Koba, Ikuro Ishii, Rindo Nakaya, Teruo Takita, Maiko Negishi, Ryoju Muramoto, Takashi |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30179870$$D View this record in MEDLINE/PubMed |
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| Keywords | Gastrointestinal endoscopy Obstructive sleep apnea syndrome Polysomnography Upper airway obstruction |
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| References | Sikkema M, de Jonge PJ, Steyerberg EW, et al: Risk of EAC and mortality in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010; 8: 235–244. Rabelo FA, Kupper DS, Sander HH, et al: A comparison of the Fujita classification of awake and drug-induced sleep endoscopy patients. Braz J Otorhinolaryngol 2013; 79: 100–105. Kawano J, Ide S, Oinuma T, et al: A protein-specific monoclonal antibody to rat liver beta 1–> 4 galactosyltransferase and its application to immunohistochemistry. J Histochem Cytochem 1994; 42: 363–369. Berry RB, Budhiraja R, Gottlieb DJ, et al: Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep. J Clin Sleep Med 2012; 8: 597–619. Campanini A, Canzi P, De Vito A, et al: Awake versus sleep endoscopy: personal experience in 250 OSAHS patients. Acta Otorhinolaryngol Ital 2010; 30: 73–77. Young T, Palta M, Dempsey J, et al: The occurrence of sleep-disordered breathing among middle-aged adults. New Engl J Med 1993; 328: 1230–1235. Mold JW, Quattlebaum C, Schinnerer E, et al: Identification by primary care clinicians of patients with obstructive sleep apnea: a practice-based research network (PBRN) study. J Am Board Fam Med 2011; 24: 138–145. Oksenberg A, Silverberg DS: The effect of body posture on sleep-related breathing disorders: facts and therapeutic implications. Sleep Med Rev 1998; 2: 139–162. Woodson BT: Diagnosing the correct site of obstruction in newly diagnosed obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 2014; 140: 565–567. Hamashima C, Fukao A; Working group for the quality assurance of endoscopic screening for gastric cancer: Quality assurance manual of endoscopic screening for gastric cancer in Japanese communities. Jpn J Clin Ooncol 2016, Epub ahead of print. Peppard PE, Young T, Palta M, et al: Prospective study of the association between sleep-disordered breathing and hypertension. New Engl J Med 2000; 342: 1378–1384. Chiu HY, Chen PY, Chuang LP, et al: Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis. Sleep Med Rev 2017; 36: 57–70. Qian Y, Xu H, Wang Y, et al: Obstructive sleep apnea predicts risk of metabolic syndrome independently of obesity: a meta-analysis. Arch Med Sci 2016; 12: 1077–1087. Gleeson K, Zwillich CW, White DP: The influence of increasing ventilatory effort on arousal from sleep. Am Rev Respir Dis 1990; 142: 295–300. Peppard PE, Young T, Palta M, et al: Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000; 284: 3015–3021. Salamanca F, Costantini F, Bianchi A, et al: Identification of obstructive sites and patterns in obstructive sleep apnoea syndrome by sleep endoscopy in 614 patients. Acta Otorhinolaryngol Ital 2013, 33: 261–266. Cavaliere M, Russo F, Iemma M: Awake versus drug-induced sleep endoscopy: evaluation of airway obstruction in obstructive sleep apnea/hypopnoea syndrome. Laryngoscope 2013; 123: 2315–2318. Baguet JP, Barone-Rochette G, Tamisier R, et al: Mechanisms of cardiac dysfunction in obstructive sleep apnea. Nat Rev Cardiol 2012; 9: 679–688. Hung J, Whitford EG, Parsons RW, et al: Association of sleep apnoea with myocardial infarction in men. Lancet 1990; 336: 261–264. Zamarron C, Garcia Paz V, Riveiro A: Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med 2008; 19: 390–398. Ulasli SS, Gunay E, Koyuncu T, et al: Predictive value of Berlin Questionnaire and Epworth Sleepiness Scale for obstructive sleep apnea in a sleep clinic population. Clin Respir J 2014; 8: 292–296. Young T, Shahar E, Nieto FJ, et al: Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Int Med 2002; 162: 893–900. Tsai HC, Lin YC, Ko CL, et al: Propofol versus midazolam for upper gastrointestinal endoscopy in cirrhotic patients: a meta-analysis of randomized controlled trials. PLoS One 2015; 10:e0117585. De Corso E, Fiorita A, Rizzotto G, et al: The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnoea syndrome: our personal experience. Acta Otorhinolaryngol Ital 2013; 33: 405–413. American Academy of Sleep Medicine: International classification of sleep disorders, 2nd Edition: Diagnostic and coding manual. Westchester, American Academy of Sleep Medicine, 2005. Sher AE, Thorpy MJ, Shprintzen RJ, et al: Predictive value of Muller maneuver in selection of patients for uvulopalatopharyngoplasty. Laryngoscope 1985; 95: 1483–1487. Shamsuzzaman AS, Gersh BJ, Somers VK: Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003; 290: 1906–1914. Certal VF, Pratas R, Guimarães L, et al: Awake examination versus DISE for surgical decision making in patients with OSA: a systematic review. Laryngoscope 2016; 126: 768–774. Hang LW, Wang HL, Chen JH, et al: Validation of overnight oximetry to diagnose patients with moderate to severe obstructive sleep apnea. BMC Pulm Med 2015; 15: 24. Goda K, Dobashi A, Tajiri H: Perspectives on narrow-band imaging endoscopy for superficial squamous neoplasms of the orohypopharynx and esophagus. Dig Endosc 2014; 26: 1–11. |
| References_xml | – reference: Hang LW, Wang HL, Chen JH, et al: Validation of overnight oximetry to diagnose patients with moderate to severe obstructive sleep apnea. BMC Pulm Med 2015; 15: 24. – reference: Salamanca F, Costantini F, Bianchi A, et al: Identification of obstructive sites and patterns in obstructive sleep apnoea syndrome by sleep endoscopy in 614 patients. Acta Otorhinolaryngol Ital 2013, 33: 261–266. – reference: Hamashima C, Fukao A; Working group for the quality assurance of endoscopic screening for gastric cancer: Quality assurance manual of endoscopic screening for gastric cancer in Japanese communities. Jpn J Clin Ooncol 2016, Epub ahead of print. – reference: Kawano J, Ide S, Oinuma T, et al: A protein-specific monoclonal antibody to rat liver beta 1–> 4 galactosyltransferase and its application to immunohistochemistry. J Histochem Cytochem 1994; 42: 363–369. – reference: Mold JW, Quattlebaum C, Schinnerer E, et al: Identification by primary care clinicians of patients with obstructive sleep apnea: a practice-based research network (PBRN) study. J Am Board Fam Med 2011; 24: 138–145. – reference: Rabelo FA, Kupper DS, Sander HH, et al: A comparison of the Fujita classification of awake and drug-induced sleep endoscopy patients. Braz J Otorhinolaryngol 2013; 79: 100–105. – reference: Qian Y, Xu H, Wang Y, et al: Obstructive sleep apnea predicts risk of metabolic syndrome independently of obesity: a meta-analysis. Arch Med Sci 2016; 12: 1077–1087. – reference: De Corso E, Fiorita A, Rizzotto G, et al: The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnoea syndrome: our personal experience. Acta Otorhinolaryngol Ital 2013; 33: 405–413. – reference: Young T, Shahar E, Nieto FJ, et al: Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Int Med 2002; 162: 893–900. – reference: Baguet JP, Barone-Rochette G, Tamisier R, et al: Mechanisms of cardiac dysfunction in obstructive sleep apnea. Nat Rev Cardiol 2012; 9: 679–688. – reference: Peppard PE, Young T, Palta M, et al: Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000; 284: 3015–3021. – reference: American Academy of Sleep Medicine: International classification of sleep disorders, 2nd Edition: Diagnostic and coding manual. Westchester, American Academy of Sleep Medicine, 2005. – reference: Goda K, Dobashi A, Tajiri H: Perspectives on narrow-band imaging endoscopy for superficial squamous neoplasms of the orohypopharynx and esophagus. Dig Endosc 2014; 26: 1–11. – reference: Sikkema M, de Jonge PJ, Steyerberg EW, et al: Risk of EAC and mortality in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010; 8: 235–244. – reference: Woodson BT: Diagnosing the correct site of obstruction in newly diagnosed obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 2014; 140: 565–567. – reference: Gleeson K, Zwillich CW, White DP: The influence of increasing ventilatory effort on arousal from sleep. Am Rev Respir Dis 1990; 142: 295–300. – reference: Chiu HY, Chen PY, Chuang LP, et al: Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis. Sleep Med Rev 2017; 36: 57–70. – reference: Oksenberg A, Silverberg DS: The effect of body posture on sleep-related breathing disorders: facts and therapeutic implications. Sleep Med Rev 1998; 2: 139–162. – reference: Shamsuzzaman AS, Gersh BJ, Somers VK: Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003; 290: 1906–1914. – reference: Certal VF, Pratas R, Guimarães L, et al: Awake examination versus DISE for surgical decision making in patients with OSA: a systematic review. Laryngoscope 2016; 126: 768–774. – reference: Peppard PE, Young T, Palta M, et al: Prospective study of the association between sleep-disordered breathing and hypertension. New Engl J Med 2000; 342: 1378–1384. – reference: Ulasli SS, Gunay E, Koyuncu T, et al: Predictive value of Berlin Questionnaire and Epworth Sleepiness Scale for obstructive sleep apnea in a sleep clinic population. Clin Respir J 2014; 8: 292–296. – reference: Hung J, Whitford EG, Parsons RW, et al: Association of sleep apnoea with myocardial infarction in men. Lancet 1990; 336: 261–264. – reference: Berry RB, Budhiraja R, Gottlieb DJ, et al: Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep. J Clin Sleep Med 2012; 8: 597–619. – reference: Sher AE, Thorpy MJ, Shprintzen RJ, et al: Predictive value of Muller maneuver in selection of patients for uvulopalatopharyngoplasty. Laryngoscope 1985; 95: 1483–1487. – reference: Campanini A, Canzi P, De Vito A, et al: Awake versus sleep endoscopy: personal experience in 250 OSAHS patients. Acta Otorhinolaryngol Ital 2010; 30: 73–77. – reference: Cavaliere M, Russo F, Iemma M: Awake versus drug-induced sleep endoscopy: evaluation of airway obstruction in obstructive sleep apnea/hypopnoea syndrome. Laryngoscope 2013; 123: 2315–2318. – reference: Young T, Palta M, Dempsey J, et al: The occurrence of sleep-disordered breathing among middle-aged adults. New Engl J Med 1993; 328: 1230–1235. – reference: Zamarron C, Garcia Paz V, Riveiro A: Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med 2008; 19: 390–398. – reference: Tsai HC, Lin YC, Ko CL, et al: Propofol versus midazolam for upper gastrointestinal endoscopy in cirrhotic patients: a meta-analysis of randomized controlled trials. PLoS One 2015; 10:e0117585. |
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| SubjectTerms | Aged Airway Obstruction - complications Airway Obstruction - diagnostic imaging Airway Obstruction - epidemiology Cross-Sectional Studies Endoscopy, Digestive System Female Humans Incidence Male Middle Aged Original Paper Polysomnography Retrospective Studies Sleep Apnea, Obstructive - diagnosis Sleep Apnea, Obstructive - epidemiology Sleep Apnea, Obstructive - etiology Tokyo - epidemiology |
| Title | Efficacy of Upper Gastrointestinal Endoscopic Examination to Identify Patients with Obstructive Sleep Apnea Syndrome: A Retrospective Cross-Sectional Study |
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