Are Drug-Induced Sedation Endoscopy–Based Predictors Better Predictors of Uvulopalatopharyngoplasty Outcomes?

Esuabom Dijemeni, Gabriele D'Amone, Israel Gbati
2017 Otolaryngology and head and neck surgery  
We read with great interest the meta-analysis presented by Choi et al. 1 We congratulate the authors for the robust statistical approach undertaken in the meta-analysis. Our interest in this article relates to the predictor selection process. Our letter focuses on 4 questions. First, is visualization of palatal obstruction during druginduced sedation endoscopy (DISE) a better visual predictor? 2 The Friedman staging system is usually used for upper airway analysis during the wake state. It has
more » ... een shown that upper airway assessment during the sedated sleep state is significantly different from the awake state. 3 Hence, this makes us postulate that visualizing palatal obstruction during sedated sleep will be a better predictor than that during the wake state. Second, is obstruction in obstructive sleep apnea predominantly a multisegmental obstruction as compared with a singlesite obstruction? 4 This meta-analysis excludes studies where other surgical procedures were performed simultaneously with uvulopalatopharyngoplasty (UPPP). This raises 2 critical comments. First, if obstruction is multisegmental, it will be easier in clinical practice to carry out a multisegmental surgical procedure. 3 Second, UPPP-only treatment will most likely lead to no long-term improvement if obstruction is truly multisegmental. Third, is a DISE classification system (ie, VOTE classification system) a better classification system for predicting outcomes for UPPP? 5 We hypothesize that a DISE classification system will more likely successfully predict UPPP outcomes because such a grading system scores a more representative form of obstruction during sleep. Hence, the VOTE classification system will be a better framework than the Friedman staging system. We acknowledge that choosing the right DISE classification system is challenging due to multiplicity of DISE classification systems. 5 Fourth, does dynamic assessment of obstruction in obstructive sleep apnea provide better predictor features for UPPP as compared with static assessment? DISE provides 3-dimensional multisegmental visualization of obstruction during sleep. 2 It provides more useful information on palatal obstruction in terms of its obstruction configuration and severity. This is not possible during a relatively static awake assessment. In conclusion, we applaud the authors for attempting to answer a very complex question: What is the best predictor for UPPP outcomes?
doi:10.1177/0194599817710442 pmid:28669303 fatcat:ng6peflzmfhedgxxz4ixwuoqvm