الفهرس 
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Abstract
Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing, with a prevalence of 2-4% in the adult population and an increasing rate of morbidity and mortality. Recognition of the actual site of obstruction is the main step in the management of OSA. Several approaches, involving clinical examination, Mueller’s maneuver and different radiological modalities were used to assess the airway obstruction for those cases. Nevertheless, the majority of tests are conducted on sleepless cases and do not give accurate impact on natural sleep. DISE has the benefit of approaching normal sleep condition by artificial pharmacological induction of sleep. Aim of the work. In this study, we aim to evaluate a new dynamic modality of CPAP titration by drug induced sleep endoscopy (DISE). The current study hypothesized that CPAP utilization with direct visualization of the collapsed structure is considered efficient as a Polysomnography titration in determination of the optimal pressure. The present study, the usage sleep endoscopy as a mean of CPAP titration by direct vision of the actual position of the collapse and manually elevate CPAP pressure until no collapse was noticed. We aimed to evaluate a new dynamic modality of CPAP titration by drug induced sleep endoscopy (DISE). This study was performed to assess DISE as a titration tool for CPAP in obstructive sleep apnea cases. We included a total of 60 cases with a mean age of 46.12 years (range, 33 – 63), there were 47 males (78%) and 13 females (22%). In this study, the mean BMI of the included cases was 38.98 kg/m2. In the current study, nine cases (15%) were having a Mallampati score II. Scores III and IV were present in 43% and 42% of the study cases respectively. Epworth sleepiness scale had a mean of 10.33 (range, 0 – 18). The other two questionnaires (Berlin and STOP-BANG) had a mean of 2.45 and 5.50 respectively. DISE revealed nasal septum deviation in 30 cases (50%) while hypertrophied tonsils were present in eight cases (13%). Moreover, vellum was detected in all cases, but concentric type was the commonest one encountered (36 cases – 60%). Oropharyngeal lateral obstruction was present in 33 cases (55%) whereas prolapsed epiglottis was detected in 33 cases (55%). No complications were recorded during the study period (delayed recovery, epistaxis, etc.). CPAP titration was done by three titration methods in this study by DISE, by equation, and manual CPAP titration. CPAP titration results did not differ significantly between those three titration methods. In this study, there were no significant association among CPAP titration level and anthropometric measurements, involving BMI and NC, but strong association were present among the CPAP titration level and PSG variables, involving AHI. In addition, the collapse pattern did not significantly correlate with CPAP titration pressure measured by DISE. In conclusion, we thought that our results can increase the function of DISE as a mean (by combination of two well-approved and broadly utilized procedures) to explain the mechanisms inducing poor CPAP compliance and to detect the actual position of the collapse and successfully manage it with CPAP or the structures which might be treated by oral appliance method or surgery to enhance CPAP compliance. In addition, the current study aimed to emphasize on the fact that the patients by this tool not an urgent need for prolonged hospital stay aiming to decrease the duration of their admission with subsequent reduction of the required charge.