Abstract
Objectives: Snoring and OSAS are caused by segmental narrowing across the upper airway due to reduced dilatory muscle activity during natural sleep. Different structures as uvula, velum, lateral pharyngeal walls, tongue base, and epiglottis may be involved in vibration or collapse. Surgical treatment success and limitation of side effects and complications depend on the exact identification of the affected anatomical structures. Until now, it has been difficult to relate endoscopic results during the wake state to conditions during sleep. Fiberoptic assessment during natural sleep is time-consuming and difficult to perform. Video-endoscopy using propofol-induced sleep can identify anatomical sites of narrowing aided by a number of specific passive maneuvers. Consequently, indication, choice, and invasiveness of surgical procedures are based on the outcome of these tests.
Methods: PSE is administered based on data of polysomnographic monitoring conducted prior to PSE. After decongestion and topical anesthesia of the nasal mucosa, subsequent levels from the nose to the larynx can be examined in vivo. ECG and oxygen saturation are monitored continuously. Passive maneuvers during PSE include partial and complete nasal obstruction and various mandible, head, and body positions.
Results: Based on the experience of more than 2000 PSEs, the video presentation includes typical pathologic findings of all involved structures as well as postoperative results.
Conclusions: With the help of PSE, the optimal selection and combination of surgical procedures in cases of habitual snoring and OSAS can be improved. The surgical procedure itself may be performed adapted to the individual dynamic findings and passive maneuvers during PSE.