Pharyngeal and bronchial endoscopic study in the diagnosis and treatment of sleep apnea syndrome

Obstructive sleep apnoea syndrome (OSAS) is a frequent and severe condition due to repeated obstruction of the upper airways during sleep. Sixty-five patients (57 men, 8 women) with clinical sleep apnoea syndrome were explored by pharyngeal endoscopy during wakefulness and during sleep induced by propofol, this anaesthetic agent enabling the patient to retain automatic respiratory movements. Nocturnal polygraphy was positive (apnoea-hypopnoea index greater than 10) in 60 patients (53 men, 7 women) and negative (less than 10) in 5 patients. The terms narrowing and obstruction were defined from our description of the pharyngeal cavity as seen at endoscopy. Endoscopic exploration during wakefulness displayed 4 pharyngeal lesions (2 cancers and 2 benign tumours) which were not responsible for the patients' OSAS. Forty-eight patients had narrowing of the pharynx (oropharynx in 45, nasopharynx in 3). Endoscopic exploration during sleep revealed inspiratory obstruction of the pharynx in 43 patients and inspiratory bronchial collapse in 1 patient. This study shows that the endoscopic findings can predict the efficacy of continuous positive pressure respiration in 97.3 percent of patients with obstruction of the oro and hypopharynx. The efficacy of uvulo-palato-pharyngoplasty in patients with obstructed oropharynx is questioned. The value of maxillary and/or mandibular surgical protrusion is discussed.