gms | German Medical Science

Videosomnoscopy (VSS) is an established and in the mean time accepted diagnostic tool in treatment and investigation of OSA. At the same time our knowledge about the role of reflux disease in airway disorders like UARS and OSA has improved substantially. Gastroesophageal reflux (GERD) and extraesophageal reflux (EERD) are often coincident in OSA patients and play to our opinion a major role, especially in advanced sleep apnea. Even so newer reports suggest that incidence of reflux could be lower during sleep, we believe that reflux disorders like GERD, EERD, LPR are in part caused by intrathoracal pressure changes induced by obstruction disordered breathing in OSA and even UARS. Intrathoracal negative pressure can lead to invagination of gastric cardia into terminal esophagus and thus promote formation of axial hernia. During our investigations in more than 3600 somnoscopies we began to perform somno-esophagoscopy in patients with OSA and UARS.

Videosomno-esophagoscopy (VSES) is a new endoscopic approach to understand and visualize the effects of thoracal pressure changes upon the upper digestive tract during obstructive breathing. So far, we conducted 112 VSES in our unit. 33 of them had been carried out after conventional VSS, using a 4,9 mm children gastroscope (Olympus GIF N 180) to perform both procedures. Even so handling an ultrathin gastroscope for VSS and upper digestive tract is more challenging, the learning curve is steep and results impressing. We found, especially in OSA patients with reflux symptoms, in all cases a more or lesser pronounced invagination of cardial and fundus mucosa into terminal esophagus, raising suspicion that obstruction plays a major role in the development of axial hernia. More than that, we found that invagination occured particularly and more pronounced in patients with supraglottic obstruction on epiglottis level, than other obstruction levels like soft palate or base of tongue. When obstruction suspends, the invagination phenomenon will no longer be detectable in these patients.

The obstruction induced invagination phenomenon was massive in 3 cases and associated with spontaneous regurgitation up to 8 times/day (1patient). All 3 patients were diagnosed for supraglottic obstruction (adult acquired Laryngomalacia) and received Laser assisted epiglottis partial resection (LAEPR). Emesis disappeared completely in 2 cases and suspended subtotally in 1 case.

After conventional somnoscopy, VSES can also be carried out using a thicker (max 9mm) gastroscope, but the width of the instrument can impair results by altering position of larynx and reducing or even increasing obstruction on supraglottic level, since the instrument cannot be inserted transnasally, but only using oropharyngeal route. Therefore the use of a low diameter, nasogastral route insertable gastroscope is recommended for VSES.

VSES could be a reasonable tool to further investigate the interrelations between OSA and reflux diseases of upper digestive tract.