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首页> 美国卫生研究院文献>Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine >DISE-PAP: a method for troubleshooting residual AHI elevation despite positive pressure therapy
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DISE-PAP: a method for troubleshooting residual AHI elevation despite positive pressure therapy

机译：探讨：尽管积极压力疗法但仍有遗漏AHI高程故障排除方法

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摘要

Despite excellent positive airway pressure (PAP) adherence, a subset of patients with obstructive sleep apnea experience residual elevation of the apnea-hypopnea index (AHI). Drug-induced sleep endoscopy during PAP application provides an opportunity to examine the anatomic effect of PAP therapy on the upper airway and to troubleshoot refractory residual AHI elevation. We present a patient who demonstrated persistent moderate-severe AHI elevation during titration polysomnogram and subsequent data download reports despite numerous mask refits, chin strap, positional modifications, and multiple pressure and mode adjustments in both the clinic and sleep laboratory settings. Drug-induced sleep endoscopy was performed with the flexible endoscope passed through the PAP circuit into the upper airway. Jaw laxity and associated mandibular retrusion at sleep onset was found to result in a complete fixed tongue base obstruction that PAP therapy, delivered via the patient’s oronasal interface, was unable to overcome. Various strategies to overcome these obstacles are discussed.
机译：尽管具有优异的正气道压力（PAP）依从性，但阻塞性睡眠呼吸暂停患者的子集经历了呼吸暂停症的残留升高（AHI）。在PAP申请期间药物诱导的睡眠内窥镜检查提供了检查PAP疗法对上呼吸道的解剖学效果，并解决耐火剩余AHI升高。我们展示了一名患者在滴定多面动图和随后的数据下载报告期间展示了持续的中度严重的AHI高度，尽管诊所和睡眠实验室设置中有许多面膜改装，CHIN表带，位置修改和多重压力和模式调整。用柔性内窥镜通过PAP电路进入上气道的柔性内窥镜进行药物诱导的睡眠内窥镜。发现睡眠发作的下颌松弛和相关的下颌撤回导致通过患者的Oronasal界面提供的PAP疗法的完整固定舌底阻塞无法克服。讨论了克服这些障碍的各种策略。

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