ABSTRACT

The problem of determining site is also a major issue in the treatment of OSA and UARS. Preoperative assessment of the site(s) of obstruction is simply not good enough at this time. Physical examination, Mallampati evaluation, lateral cephalometric x-rays, and fiberoptic endoscopy with Mueller maneuver all have severe limitations as to determining the site or sites of obstruction in a given patient. The OSA patient needs to be evaluated during sleep. The best objective test, in my opinion, to determine the site of obstruction is a multilevel pressure measurement during sleep (10). This is not routinely performed for a number of reasons. Sleep laboratories have no incentive to do such testing since nasal continuous positive airway pressure corrects obstruction at all levels; site(s) determination is of interest primarily to the surgeon. Current reimbursement schemes would need to be modified to pay for such additional testing; sleep laboratories would need to receive incentive from surgeons to perform such tests or the surgeons would need to support specialized testing systems that provide such data. Esophageal pressure measurements during sleep have allowed us to diagnose UARS; a single pressure measurement in the upper esophagus reflects the negative intrathoracic pressure needed for inspiration during sleep. A similar test using multilevel pressure sensors would provide us with a measurement of obstruction at the palate and base of the tongue.