Natural Sleep and Drug-induced Sleep Endoscopy

NCT ID: NCT03004014

Last Updated: 2018-07-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

28 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-01-31

Study Completion Date

2018-01-31

Brief Summary

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Drug induced sleep endoscopy (DISE) has been performed worldwide since 1991 to determine the site and configuration of upper airway obstruction in patients with obstructive sleep apnea (OSA). However, there are no studies comparing DISE to sleep endoscopy during natural sleep. Objectives: To compare DISE to natural sleep endoscopy in OSA patients referred for surgical treatment.

Methods: OSA patients referred to surgical treatment (lateral pharyngoplasty) will be enrolled in this study. Natural sleep endoscopy will be performed at the sleep lab during the night. Propofol induced sleep will be performed at the operating room before surgery. The VOTE (velum, oropharyngeal lateral walls, tongue base and epiglottis) classification will be used to compare site and configuration of collapse between studies. Peak inspiratory flow will also be compared between studies.

Detailed Description

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Drug induced sleep endoscopy (DISE) has been performed worldwide since 1991 to determine the site and configuration of upper airway obstruction in patients with obstructive sleep apnea. However, there are no studies comparing DISE to sleep endoscopy during natural sleep. Objective: to compare natural sleep endoscopy to drug induced sleep with propofol.

The study population will include 28 patients who are candidates to surgical treatment.

Methods Detailed clinical history and physical examination will be performed before natural sleep endoscopy. A 2-hour fast will be required. During both natural sleep and propofol-induced sleep, pharyngeal pressure will be measured using a pressure-tipped catheter (model TC-500XG; Millar).The nasopharynx will be numbed with xylocaine (10%) and oxymetazoline (0.05%), the catheter will be passed through a nasal mask into one nostril, and placed at the tongue base as confirmed by visual inspection of the oropharynx.A 2.8mm pediatric bronchoscope (Olympus) will be passed through the mask and into the other nostril. A nasal mask will be fitted and a heated pneumotachograph with differential pressure transducer connected to the mask will quantify airflow. The endoscope will be located at velopharynx, lateral wall of the pharynx and 2 cm above tongue and epiglottis.The VOTE Endoscopic Classification will be used to describe site and configuration of pharyngeal collapse in each study. The study will be scored by two experienced investigators, blind to the patient identification and type of study (natural sleep or drug-induced). Propofol-induced sleep will be performed at the operating room before surgery.

Conditions

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Obstructive Sleep Apnea

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Natural Sleep

OSA subjects referred for surgical treatment will evaluated endoscopically during natural sleep

Group Type NO_INTERVENTION

No interventions assigned to this group

Propofol Induced Sleep

Sleep endoscopy during propofol induced sleep

OSA subjects referred for surgical treatment will be evaluated endoscopically during propofol induced sleep

Group Type OTHER

Sleep endoscopy during propofol induced sleep

Intervention Type OTHER

It will be performed a sleep endoscopy during drug induced sleep endoscopy

Interventions

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Sleep endoscopy during propofol induced sleep

It will be performed a sleep endoscopy during drug induced sleep endoscopy

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* BMI less than 35kg/m2
* Apnea-hypopnea index \> 5 events/hour of sleep
* Clinical indication of surgical treatment for sleep apnea

Exclusion Criteria

* Severe or decompensated cardiac or respiratory diseases
* Previous pharyngeal surgery
* Tonsils grade III or IV
* Other sleep disturbance (parasomnias, primary insomnia, narcolepsy)
* Sedative medication use (opioids, benzodiazepines and muscle relaxants)
* Uncontrolled diabetes or hyperthyroidism
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Pedro Rodrigues Genta

OTHER

Sponsor Role lead

Responsible Party

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Pedro Rodrigues Genta

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Pedro R Genta, Post Doc

Role: PRINCIPAL_INVESTIGATOR

Sleep Laboratoy, Heart Institute

Locations

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Sleep Laboratory, Heart Institute, Pulmonary Division, Hospital das Clínicas da Universidade de São Paulo

São Paulo, São Paulo, Brazil

Site Status

Countries

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Brazil

References

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Ordones AB, Grad GF, Cahali MB, Lorenzi-Filho G, Sennes LU, Genta PR. Comparison of upper airway obstruction during zolpidem-induced sleep and propofol-induced sleep in patients with obstructive sleep apnea: a pilot study. J Clin Sleep Med. 2020 May 15;16(5):725-732. doi: 10.5664/jcsm.8334. Epub 2020 Feb 7.

Reference Type DERIVED
PMID: 32029070 (View on PubMed)

Other Identifiers

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13900

Identifier Type: -

Identifier Source: org_study_id

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