الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Obstructive sleep apnea is a common disease with high rate of morbidity and mortality. Etiology is multifactorial and multilevel resulting in recurrent upper airway obstruction at different sites during sleep. Despite Polysomnography is the standard method for evaluation of OSA severity, it does not provide any information concerning what structure specifically caused the obstruction or the degree of pharyngeal narrowing. However, there are multitude of diagnostic tools, each technique has limitations, and no gold standard method has been established up till now. So, complete clinical assessment of upper airway to identify the site and pattern of obstruction precisely together with other diagnostic methods which vary from static to dynamic tools is a crucial step during evaluation of OSA patients. This will help to give rise to better outcomes of different surgical procedures for OSA.
Our study was conducted on 30 patients attending Otorhinolaryngology outpatient clinic with OSA. All patients underwent complete clinical evaluation then attended overnight PSG for assessment of OSA severity. Then, patients evaluated by DISE using propofol induced sedation with flexible nasopharyngeoscope. Once patients started snoring and O2 desaturation, upper airway was examined from the nose/ naso-oropharynx to larynx and hypopharynx for assessment of obstructive sites and patterns. Then dynamic sleep MRI using propofol induced sedation was done. MRI Images were obtained from the skull base to the level of the lower cervical trachea. Multiple imaging sequences were performed including axial, and sagittal T2-weighted images, with fast cine MR images obtained in the midline sagittal location and in the axial plane at the level of the retropalatal and retroglossal. Eighty consecutives dynamic MR images were obtained at the midline sagittal creating a real-time “movie” of dynamic airway motion. Sagittal images were used to classify the obstruction as either retropalatal, retroglossal, or both, whereas axial images were used to evaluate the different patterns of airway obstruction.
The aim of this work was to assess the role of drug induced sleep endoscopy DISE, versus dynamic sleep MRI in evaluating patients with OSA.
Based on Polysomnographic findings, 46.7% of patients had severe OSA, 26.7% had moderate OSA and 26.7% had mild OSA.
According to DISE, all patients 100% had velopharyngeal (retropalatal) collapse; 80% had circular pattern of collapse OC and 20% had Anteroposterior collapse OAP. 53.3% of patients had hypopharyngeal (retroglossal) collapse; 26.7% with Anteroposterior direction HAP, 23.3% in transverse direction Ht and 3.3% in circular direction Hc.
According to dynamic sleep MRI, 100% of patients had retropalatal obstruction; 73.3% with Circumferential collapse, 20% had Anteroposterior collapse and 6.7% of patients had Transverse pattern of collapse.
46.7% of patients had retroglossal obstruction; 23.3% had Anteroposterior collapse, 3.3% had Transverse pattern of collapse and 20% with Circumferential collapse.
According to our study, most common site of obstruction in OSA patients is retropalatal followed by retroglossal.
Circular pattern of obstruction is much more common at the retropalatal and anterior-posterior pattern at retroglossal.