Sleep nasendoscopy

I’m a relative newcomer to this forum and to CPAP generally, but I thought I’d share part of my experience after searching and seeing nothing similar.

To make a long story short, I had several polysomnographies in the US that I felt underestimated my problem. Since the data showed “moderate” apnea levels, and because I’m young and don’t have a weight problem, the doctors essentially sent me away with a dental appliance and tips on “positional therapy.”

Despite this my daytime fatigue and snoring continued and even got worse. I then had both pillar implants and LAUP and neither helped. At this point I had moved to the UK, although I had continued to be seen by doctors in the US. However I decided to see someone here - an ENT - after reading about his work online.

This doctor has pioneered research on a procedure that is relatively common in Europe but has yet to be approved by the insurance companies in the states. It’s called sleep nasendoscopy. Basically they put you under using mild general anaesthesia designed to mimic sleep and then examine your airway using an endoscopy tube — the exam the ENT does when you’re in the office and awake. The idea is to answer a very basic question: what part of the anatomy is actually causing the problem? For me, since the only “abnormal” anatomical thing (the soft palate) had already been fixed, the results were very important in determining my treatment.

I have some of the research on this in PDF files and can send them to whomever is interested.

For those struggling with CPAP compliance or contemplating surgery, it seems a very logical procedure. I just hope it becomes available in the US soon.

So uhhhh ... if it was not your soft palate, what was it? ... what type of treatment did you end up with? ... did it cure your moderate apnea?

- roberto

my ENT scoped me years ago, nothing new about the Nasendoscopy exam.

A Nasendoscopy is the examination of the nose and upper airways by the use of a small flexible tube (endoscope), this allows a doctor to examine the lining of these areas. The examination looks at the nose (nasal cavity), the back of the nasal cavity (nasopharynx), the back of the mouth and tongue (oropharynx) and the upper part of the voice box (laryngo-pharynx). The area to be examined is illuminated by a light. Images of the area are transmitted via optical fibres within the endoscope to a viewing port or TV monitor.

The Pillar and LAUP many times fail because they don't prevent the tongue from falling into the back of the throat, most likely cause why they didn't work for you. Some relief might be found with the dental device but practice has shown it only works for mild OSA and not recommended for moderate to severe OSA.

Nearly every PSG ever done proves you have fewer SDB events sleeping on your side or stomach than on your back.

There can be other causes for chronic fatigue such as autoimmune disorders like lupus.

DreamStalker wrote:So uhhhh ... if it was not your soft palate, what was it? ... what type of treatment did you end up with? ... did it cure your moderate apnea?

- roberto

Sorry; didn’t get into details because I just wanted to mention the procedure. I put “moderate” in quotation marks for a reason — my O2 levels don’t drop but I have lots of respiratory-effort related arousals that cause the fatigue. the sleep nasendoscopy showed severe upper airway collapse caused mostly by the tongue but significantly exacerbated by a birth defect I have called (mild) pectus excavatum (slightly indented sternum), which nobody had mentioned as a culprit before. The thought is that I could go for another surgery, this time for the tongue, but that the negative pressure from lower in the airway would likely negate the effects. On the other hand, it could make CPAP easier to tolerate.

So they’ve given me CPAP and are still contemplating the other surgeries. I haven’t been able to sleep with the mask for more than a few hours after 2 weeks of attempts, but I’m still trying, taking into account all the suggestions posted in this forum.

The sleep nasendoscopy came too late for me in that I had already gone through the pain of two surgeies to no effect. That said, it documented (they even give you color photos of what they saw!) exactly what was going on and suggested a way forward with more certainty of success. For those who want to make CPAP work via surgery, it would suggest which surgery would be most appropriate. For those with CPAP who don’t want to be, it could suggest which surgery might be most effective.

Part of the notion behind this is that it’s very difficult to look at the airway of an awake person and divine what’s going to happen when he/she is asleep. Everyone’s anatomy changes differently when they sleep. No sleep study will show you that.

Snoredog wrote:my ENT scoped me years ago, nothing new about the Nasendoscopy exam.

A Nasendoscopy is the examination of the nose and upper airways by the use of a small flexible tube (endoscope), this allows a doctor to examine the lining of these areas. The examination looks at the nose (nasal cavity), the back of the nasal cavity (nasopharynx), the back of the mouth and tongue (oropharynx) and the upper part of the voice box (laryngo-pharynx). The area to be examined is illuminated by a light. Images of the area are transmitted via optical fibres within the endoscope to a viewing port or TV monitor.

The Pillar and LAUP many times fail because they don't prevent the tongue from falling into the back of the throat, most likely cause why they didn't work for you. Some relief might be found with the dental device but practice has shown it only works for mild OSA and not recommended for moderate to severe OSA.

Nearly every PSG ever done proves you have fewer SDB events sleeping on your side or stomach than on your back.

There can be other causes for chronic fatigue such as autoimmune disorders like lupus.

Yes, the endoscopy is not new, but the sleep nasendoscopy is different in that it is conducted while the patient is, in effect, sleeping. As I mentioned, what happens to the anatomy when someone is asleep is hard to predict based on what you can see when they’re awake.