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Did a Sleep Endoscopy help you out?
#1
Hi all,

The past few months have been though as treatment with my bipap has not been working for mild apnea uars .  Or at least not as much as I hoped . I tried several pressure ranges without really much success , unfortunately . 

My pulmonologist send me to an ENT that is specialised in sleep endoscopy and apnea surgery . The ent adviced a radio frequency reduction of My turbinates, which i had done 2 weeks ago to sleep better with my PAP

Finally I can breath smoothly through my nose during the day and night ! 

 But more importantly he wanted to do a sleep endoscopy. The endoscopy is planned in 2 weeks. He wanted to know what causes my long hypoapneas. My girlfriend also notices these when I am asleep and it is pretty scary for her

Now my question is, did anyone have a sleep endoscopy and did that result in a successful surgery plan?

Mind you, this hospital uses a lot of laser surgery and repositioning surgery. So no UPPP involved Smile

Thanks
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#2
Let your doctor know we are interested in learning more about this, and will be following the procedure and outcome. Sleep endoscopy is not a common procedure, and is pretty expensive. Can you describe more how this is performed? Is sedative or anesthesia use? Is it done with bilevel pressure to see what pressure and pressure support can relieve any restriction? Anyway, good luck and report back.
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#3
My sleep endoscopy led to UPPP. I was given the same type of a sedative they give during a colonoscopy, Not a full anesthesia. No pressure. No cpap. Just me chocking and grasping for air. They wrote down which parts collapsed during it and then 2 weeks later I had UPPP.

Important part to note is that a sedative or anesthesia isnt really a reliable way of making you sleep, because you never go into deep stage 3/4 sleep nor REM, whereas deep sleep or REM are usually when apnea happen. Having said that I had half of my AHI during the procedure around 30, whereas with the sleep study i had 60.

Also from wiki:

" In order to definitively diagnose UARS, there must be a demonstrated pattern of greater negative esophageal pressures which are then followed by a rapid change to a more positive level with a sleep arousal. This can be confirmed with invasive polysomnography that uses an esophageal balloon transducer and full pneumotachograph."
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#4
Crowtor raises a good point. Your ENT is probably inclined to a surgical solution, rather than one that optimizes your VPAP ST or other PAP solution. UPPP has a lot of drawbacks, so consider your options carefully.
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#5
If CPAP is working for you now I would tend to steer clear of surgery, it only makes surgeons rich.
A lot of people has had it done and had to put up with a lot of pain, then a few years down the line they were back to where they were before it was done.  So consider your options carefully!

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#6
On a side note: I'm very happy with my UPPP. I'm definetely going to re-do the palatoplasty part of UPPP in a few years when the soft tissues regrow. The important part is to have the Modified UPPP where they keep the soft palate so theres no regurgitation of food into the nasal passage. Also Pain comes from Tonsilectomy.
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#7
Hi all,

Thanks for all the quick replies and sorry for my late response.

You guys are definitely right my ENT is inclined to a surgical solution. During our consult he clearly said that he found it even strange that a person my age was being treated with CPAP, while surgical options IF feasible are a better solution. That being said, I am not giving up on my PAP! Just want some more clarification on my obstruction cause.

To comeback to what you said sleep2snore, CPAP is not working for me and as a matter of fact my ENT thinks he will see a lot more during the sleep endoscopy than a sleep study will show. Because I do not hit deep sleep at all, and because of my hypersensitive upper airway I keep on having arousals without having full blown apnea's.  @ Crowter I agree with you, the endoscopy just lasts 15-20 minutes, doesnt replicate all the real sleep stages. It does however put you in stage 3/4 sleep which is deep sleep, you are not in your REM sleep though during the endoscopy.

@Sleeprider, During the endoscopy you are being sedated by a team of anaesthesiologists, I have no clue what they will use to sedate me !

Check these video's of patients that show severe obstruction during their endoscopy, they are young and their sleep studie's show mild apnea/uars. :

1. https://www.youtube.com/watch?v=PqN6n5tlcjo
2. https://www.youtube.com/watch?v=-TUp44IWCbY


If they can adress what is obsturcting my airway may it be the tongue, eppiglottis soft palate or the anatomy of my mouth, the endoscopy is my best bet to find it out. And this hospital does not do UPPP's they use laser assisted surgery which is not that invasive.

For the ones that are interested these are the surgeries they perform:

- Inspire therapy, tongue pacemaker that stimulates the tongue (only for severe apnea)
- Celon RFITT reduction of the tongue base
- HTP (Hyoidthyroidpexie)
- MMA surgery
- Celon turbinate reduction

So as you can see there is no UPPP
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#8
I had a DISE procedure back in July. My main blockage is the base of my tongue. The ENT let me wear my ResMed Narval oral appliance during the procedure, so he could check if it was helping me. Well, it is two months later, and I still don't have a solution to my blockages. The ENT said he didnt find anything else besides my tongue blocking, and that I could move my dental appliance further forward. So I adjusted my jaw forward slowly the last two months and I still get OA's. So something else must be blocking my airway at night. Maybe my uvula?

The only option my ENT gave me, was the "Inspire" device that he could install that I turn on at night that uses electricity to keep tongue in place. I'm not going that route just yet, until I get a second and third opinion. I'm going to see him one last time to discuss other options this week. Then I'm going to a second ENT doctor to get another opinion. So I'm at a loss here, why the ENT doctor doesn't want to go forward with surgery to reduce my tongue tissues, UPPP, or reduce my nose turbinates. I have a deviated septum too which makes it hard to breathe through my nose. The doctor just keeps saying the surgeries for all of these procedures is painful with long recovery times, and didn't recommend it for me. He would rather just go to easy way, and implant that device into me.

The main problem I have with CPAP, the Inspire device he offered, and my dental appliance, is that they are all just a temporary workaround to the solution! They are a kludge! They don't fix the issue in a more permanent measure. Which is why I'm going to see another ENT that does some in-office out-patient procedures that can help open the airway.
ResMed AirCurve 10 vAuto
Pressure EPAP min 5.6, IPAP Max 16, PS 3.

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