Novel Intraoral Negative Airway Pressure in Drug-Induced Sleep Endoscopy with Target-Controlled Infusion

Figures & data

Figure 1 The intraoral negative airway pressure device.

Figure 2 A patient undergoing drug-induced sleep endoscopy in various positions with or without intermittent negative airway pressure (iNAP) therapy.

Notes: DISE was conducted multiple times for each patient in the following order: (A) Supine position with iNAP therapy, (B) Head rotation with iNAP therapy, (C) Supine position without iNAP therapy, (D) Head rotation without iNAP therapy.

Table 1 Baseline Characteristics of the Participants (n = 92)

Variable	Frequency (%) or Mean ± Standard Deviation
Male sex	75 (81.5)
Age, year	47.1 ± 12.9
Height, cm	169.7 ± 9.2
Weight, kg	75.3 ± 15.5
BMI, kg/m^2	26.3 ± 3.9
AHI, events/hours	34.2 ± 23.9
Minimum SaO2, %	78.4 ± 9.9
REM AHI, events/hours	35.5 ± 22.6
PLM, events/hours	7.4 ± 14.7

Notes: Data are presented as frequency (percentage) or mean ± standard deviation.

Abbreviations: BMI, body mass index; AHI, apnea–hypopnea index; SaO2, arterial oxygen saturation; REM, rapid eye movement; PLM, periodic limb movement.

Table 2 Changes in obstruction severity before and after intermittent negative iNAP therapy in the supine position with and without head rotation

N = 92	Supine (before iNAP)			P of McNemar
Method / After iNAP	No obstruction	Partial obstruction	Complete obstruction
Collapse pattern at velum
Supine				<0.001
No obstruction	3 (100.0)	3 (50.0)	18 (21.7)
Partial obstruction	0 (0.0)	3 (50.0)	16 (19.3)
Complete obstruction	0 (0.0)	0 (0.0)	49 (59.0)
Lateral				<0.001
No obstruction	3 (100.0)	4 (66.7)	28 (33.7)
Partial obstruction	0 (0.0)	2 (33.3)	15 (18.1)
Complete obstruction	0 (0.0)	0 (0.0)	40 (48.2)
Collapse pattern at oropharynx
Supine				0.019
No obstruction	69 (98.6)	2 (100.0)	3 (15.0)
Partial obstruction	0 (0.0)	0 (0.0)	7 (35.0)
Complete obstruction	1 (1.4)	0 (0.0)	10 (50.0)
Lateral				0.209
No obstruction	65 (92.9)	1 (50.0)	2 (10.0)
Partial obstruction	2 (2.9)	1 (50.0)	4 (20.0)
Complete obstruction	3 (4.3)	0 (0.0)	14 (70.0)
Collapse pattern at tongue base
Supine				<0.001
No obstruction	37 (94.9)	19 (70.4)	10 (38.5)
Partial obstruction	2 (5.1)	7 (25.9)	7 (26.9)
Complete obstruction	0 (0.0)	1 (3.7)	9 (34.6)
Lateral				<0.001
No obstruction	35 (89.7)	22 (81.5)	13 (50.0)
Partial obstruction	3 (7.7)	4 (14.8)	8 (30.8)
Complete obstruction	1 (2.6)	1 (3.7)	5 (19.2)
Collapse pattern at epiglottis
Supine				0.375
No obstruction	63 (91.3)	5 (83.3)	4 (23.5)
Partial obstruction	1 (1.4)	0 (0.0)	2 (11.8)
Complete obstruction	5 (7.2)	1 (16.7)	11 (64.7)
Lateral				0.007
No obstruction	67 (97.1)	5 (83.3)	11 (64.7)
Partial obstruction	1 (1.4)	0 (0.0)	3 (17.6)
Complete obstruction	1 (1.4)	1 (16.7)	3 (17.6)

Note: Data are presented as frequency (percentage).

Figure 3 Drug-induced sleep endoscopy findings at the velar level: supine position. No intermittent negative airway pressure (iNAP) therapy during (A) inspiration and (B) expiration. Application of iNAP therapy during (C) inspiration and (D) expiration.

Figure 4 Drug-induced sleep endoscopy results at the velar level: head rotation to the left. Head rotation without intermittent negative airway pressure (iNAP) therapy during (A) inspiration and (B) expiration. Head rotation with iNAP therapy during (C) inspiration and (D) expiration.

Figure 5 Drug-induced sleep endoscopy results at the oropharyngeal level: supine position. No intermittent negative airway pressure (iNAP) therapy during (A) inspiration and (B) expiration. Application of iNAP therapy during (C) inspiration and (D) expiration.

Figure 6 Drug-induced sleep endoscopy results at the tongue base level: supine position. No intermittent negative airway pressure (iNAP) therapy during (A) inspiration and (B) expiration. Application of iNAP therapy during (C) inspiration and (D) expiration.

Figure 7 Drug-induced sleep endoscopy results at the tongue base level: head rotation to the left. Head rotation without intermittent negative airway pressure (iNAP) therapy during (A) inspiration and (B) expiration. Head rotation with iNAP therapy during (C) inspiration and (D) expiration.

Figure 8 Drug-induced sleep endoscopy results at the epiglottis level: supine position. No intermittent negative airway pressure (iNAP) therapy during (A) inspiration and (B) expiration. Application of iNAP therapy during (C) inspiration and (D) expiration.

Figure 9 Drug-induced sleep endoscopy results at the epiglottis level: head rotation to the left. Head rotation without intermittent negative airway pressure (iNAP) therapy during (A) inspiration and (B) expiration. Head rotation with iNAP therapy during (C) inspiration and (D) expiration.

Table 3 Complete relief in all four sites of VOTE before and after intermittent negative iNAP therapy

N = 92	Supine (before iNAP)		P of McNemar
After iNAP	Any partial/complete obstruction	Complete relief (no obstruction)
Supine			0.016
Any partial/complete obstruction	84 (92.3)	0 (0.0)
Complete relief((no obstruction))	7 (7.7)	1 (100.0)
Lateral			<0.001
Any partial/complete obstruction	71 (78.0)	0 (0.0)
Complete relief((no obstruction))	20 (22.0)	1 (100.0)

Note: Data are presented as frequency (percentage).