human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of the present study was to compare pharyngeal and polysomnographical findings during drug-induced sleep endoscopy ( DISE ) performed with either propofol or midazolam as a single sedative agent . It is prospect i ve , non-r and omized , double-blinded case series study . Sixteen patients with sleep disordered breathing were se date d first with propofol and after full wake up with midazolam . Simultaneous polysomnography ( PSG )  was performed . We compared the zones of obstruction and vibration found with both drugs using the VOTE classification . Simultaneous PSG findings are also compared . There were 15 men and one woman ; the mean age was 42.7 years old , mean body mass index 26.9 kg/m2 .  Average DISE duration was 20 min with Propofol and 14.3 min with Midazolam . The induced sleep stage obtained was N2 with both drugs . Outpatient physical exam did not correlate with drug-induced sleep findings . There was a good correlation between DISE results with both drugs in all the areas of collapse except the velum ( p < 0.005 ) . Using a continuous perfusion , there is a good agreement in the findings observed in DISE performed with propofol and midazolam and PSG Objective : To determine the test-retest reliability of drug-induced sleep endoscopy ( DISE ) . Methods : Prospect i ve cohort study . Patients with OSA underwent two separate DISE examinations . The following outcomes were measured : a global assessment of obstruction at the palate and /or hypopharynx ; the degree of obstruction at the palate and hypopharynx ; and the contribution of individual structures ( palate , tonsils , tongue , epiglottis , and lateral pharyngeal walls ) to obstruction . Results : Thirty-two patients underwent two separate DISE examinations . The preoperative sleep study apnea-hypopnea index was 40.7 ± 21.1 , and the lowest oxygen saturation was 79.8 ± 17.4 percent . Point estimates for the intraclass correlation coefficient analogs related to palatal obstruction ranged from 0.41 to 0.89 ; related to the hypopharyngeal airway , the point estimates ranged from 0.57 to 0.84 . Conclusion : The test-retest reliability of DISE appears good , especially in the evaluation of the hypopharyngeal airway . Larger studies can generate more precise confidence interval estimates and test the generalizability of these findings Purpose Several studies have demonstrated the validity , reliability , and safety of drug-induced sedation endoscopy ( DISE ) in assessing the collapse of the upper airway ( UA ) in patients with obstructive sleep apnea hypoapnea syndrome ( OSAHS ) . The aim of this study was to assess the interobserver agreement on DISE and on therapeutic decision between an expert observer and an observer in training . Methods This was a cross-sectional study . Thirty-one DISE videos performed in our service were r and omly selected . Videos belonged to patients with OSAHS who wanted alternative treatments to CPAP .  The videos were review ed by an ENT experienced on DISE and a second observer in formation . Each observer independently assessed the presence of collapse of the UA according to a modified VOTE classification and proposed an alternative treatment to CPAP . Interobserver agreement kappa values were calculated . Results In assessing the presence of collapse at different levels of the upper airway , the percentage of agreement was 80 % at the level of the soft palate ( kappa = 0.1667 ) , 89.29 % in the oropharynx ( k = 0.7742 ) , 80.65 % at the tongue base ( k = 0.5571 ) , and 74.17 % at the epiglottis ( k = 0.4768 ) . When degree and configuration of the collapse was evaluated , the interrater agreement was moderate to good , except at the level of the tongue base where the agreement was weak for both degree and configuration of collapse ( k = 0.34 and 0.38 , respectively ) . Interobserver agreement was moderate when the indication of alternative treatments to CPAP is valued based on the findings of DISE . Conclusions Overall , DISE is a reliable technique even when assessing interobserver agreement between an experienced observer and one in training ; however , tongue base is the level of the upper airway that presents the greatest difficulties when assessing the collapse with DISE . Therefore , it is important to develop learning curves for this technique in order to obtain more reliable results Bispectral  index ( BIS ) monitor is a neurophysiological monitoring device which continually analyses a patient ’s electroencephalogram during sedation and general anaesthesia to assess the level of consciousness and depth of anaesthesia . BIS monitoring , whilst performing sleep nasendoscopy ( using midazolam and propofol ) , has helped vali date depth of sedation and allowed comparison with levels of sedation of control patients during natural sleep . A prospect i ve study of 30 patients with snoring undergoing sleep nasendoscopy with BIS monitoring was conducted .  BIS monitoring was recorded throughout the procedure and assessment of snoring was made at the appropriate level of sedation and snoring . BIS values were compared with control patients . The 30 patients undergoing sleep  nasendoscopy had average BIS values ranging from 50.72 to 61.2 . Similar results were seen with BIS and oxygen saturation in the control group . BIS monitoring provides an adjunct to the assessment of sleep nasendoscopy in determining the level of sedation required for snoring assessment . Comparable BIS values and oxygen saturation levels were obtained between controls and patients during sedation-induced sleep , thus validating the role of sleep nasendoscopy Patients with the sleep apnoea/hypopnoea syndrome ( SAHS ) have impaired daytime function with demonstrable sleepiness and impaired cognition . The hypothesis that brief arousals from sleep cause these daytime impairments was tested . One hundred and fifty patients with sleep disordered breathing were studied prospect ively , comparing  overnight polysomnography  with daytime measures of objective sleepiness , psychological well-being and cognitive performance . Significant , but weak ( r2<0.1 ) , relationships were seen between several nocturnal measures ( apnoea/hypopnoea index , arousals and desaturation variables ) and daytime measures of quality of life , well-being , subjective sleepiness , symptoms and cognitive performance . The only significant relationship between nocturnal variables and objective sleepiness was a very weak correlation ( r2<0.05 ) between the lowest oxygen saturation and mean maintenance of wakefulness test ( MWT ) result . The MWT was better correlated with daytime function than the multiple sleep latency test . This study shows a lack of strong relationships between conventional nocturnal measures and daytime function in patients with sleep disordered breathing OBJECTIVES /HYPOTHESIS This study aim ed to evaluate changes in obstruction site in obstructive sleep apnea ( OSA ) patients according to sleep position . STUDY DESIGN Prospect i ve case series . METHODS Eighty-five patients who had undergone level 1 sleep study and drug-induced sleep endoscopy in the supine and lateral positions were included . Obstruction sites were classified as soft palate ( SP ) , tongue base ( TB ) , lateral wall ( LW ) , and larynx ( LX ) . Subgroup analysis was performed according to lateral apnea-hypopnea index ( AHI ) : those with an AHI of ≥ 10 ( lateral obstructors , LO ) and those with an AHI of < 10 ( lateral nonobstructors , LNO ) . RESULTS Prevalence in obstruction site of SP , TB , and LX decreased significantly after change from supine to lateral position ( P < 0.05 ) . However , the prevalence of LW obstruction was not affected by position change . LW collapse in moderate OSA decreased ( from 66.7 % to 35.9 % ) after change to lateral sleep , whereas it persisted in severe OSA patients ( 81.6%-89.5 % ) . In the lateral position , persistent obstruction at the LW was observed more frequently in the LO group compared to the LNO group ( 83.3 % vs. 33.3 % ) . CONCLUSION When sleep posture is changed from supine to lateral , obstruction due to structures such as tongue base and larynx improves dramatically . Obstruction in lateral position is mostly due to obstruction at the oropharyngeal LWs . Therefore , position dependency is mostly determined by LW collapsibility . Evaluating the changes of the upper airway according to sleep position can further characterize the upper airway collapsibility and can be used for tailored treatment planning OBJECTIVES /HYPOTHESIS The aim of this study is to quantify the correlation between a large tongue classified by the modified Mallampati score ( MMS ) and obstruction at the tongue base observed during sleep endoscopy in patients with socially unacceptable snoring ( SUS ) and obstructive sleep apnea syndrome ( OSAS ) . STUDY DESIGN Prospect i ve . METHODS One hundred twenty-seven patients with obstructive sleep apnea and SUS underwent sleep endoscopy .  Patients were classified into four specific groups according to their MMS . After intravenous administration of midazolam , obstructive events in the upper airway were classified . The level of obstruction was expressed as palatal ( 2 ) , palatal and to a lesser degree base of the tongue/laryngeal level ( 2 ) , tongue base/laryngeal level and to a lesser degree palatal ( 3 ) , and tongue base/laryngeal level ( 3 ) . The degree of correlation between the level of obstruction and the MMS was analyzed by means of Spearman 's rank-order correlation . RESULTS No linear association between the level of obstruction and MMS could be found . A large tongue ( MMS 3 or 4 ) does not predict obstruction at the base of the tongue . Patients classified as MMS 1 or 2 did not frequently show obstruction at the base of the tongue ( 9 of 38 , 23,6 % ) . The majority of the population showed retropalatal obstruction . A large tongue ( MMS 3 or 4 ) was often accompanied by retropalatal obstruction , 76 % of the cases ( 64 of 89 ) . CONCLUSIONS No positive correlation exists between a large tongue and obstruction at tongue base level . In both groups , retropalatal obstruction occurred more often than retrolingual obstruction .  Sleep endoscopy provides qualitative insight into important changes during sleep in patients with SUS and OSAS . In addition , anatomic aberrations are clearly visualized in a dynamic setting . Classification of the size of the tongue , as assessed by the MMS , may be of great importance as well It has been proposed that sleep nasendoscopy ( SN ) will improve the success rate of the uvulopalatopharyngoplasty operation by identifying those patients with palatal snoring . The aim of this study was to test the efficacy of SN in the management of snorers who do not have obstructive sleep apnoea . This study compared a group of 26 snorers managed without SN ( group A ) to a group of 27 snorers managed with SN ( group B ) . The post-operative results of group A were 61 per cent cured , 27 per cent better and 8 per cent unchanged . Group B results were 76 per cent cured , 19 per cent better and 5 per cent unchanged . However , if patients with only palatal snoring had surgery , the results for group B would have been 94 per cent cured , 6 per cent better and 0 per cent unchanged ( 95 per cent C.I. of difference + 0.14 , + 0.54 , p = 0.017 ) . The results confirm the predictive power of SN in identifying success following  uvulopalatopharyngoplasty .  A simple grading system is suggested to aid in treatment planning . Patients are divided into three categories on SN : palatal snorers , mixed snorers and non-palatal ( tongue base ) snorers . It is proposed that uvulopalatopharyngoplasty may cure palatal snorers but mixed snorers will need additional therapies to eliminate their snoring although uvulopalatopharyngoplasty may improve the symptoms Sixty patients diagnosed with obstructive sleep apnea syndrome ( OSAS ) underwent uvulopalatopharyngoplasty ( UPPP ) .  The effects of surgery were studied based on endoscopic findings during drug-induced sleep and determination of the apnea-hypopnea index ( AHI ) before and after the operation . Changes in the form of the airway during sleep in the recumbent position were observed , and the role of upper airway endoscopy in the diagnosis and surgical treatment of OSAS was determined . The site of airway obstruction during sleep induced by i.v . injection of 10 mg of diazepam was classified into five types , and changes in AHI and the site of airway obstruction were compared before and after surgery . Changes in airway morphology during sleep in the supine and recumbent positions were also compared before surgery . The postoperative improvement rate was 74.4 % for the soft palatal type of obstruction , 76.2 % for the tonsillar type , 53.3 % for the circumferential palatal type and 34.0 % for the mixed type . Treatment produced excellent or good effects for the soft palatal and tonsillar types of obstruction . However , many patients with the circumferential palatal and mixed types of obstruction showed only some improvement or no change . Good airway morphology was maintained in the recumbent position by patients with the soft palatal type of obstruction . With the circumferential palatal and mixed types of obstruction , improvement can be expected from operations which include surgical treatment of the posterior pharyngeal wall or lateral funiculus , or with midline laser glossectomy . A good operative outcome can be predicted in patients showing improvement of apnea in the recumbent position preoperatively OBJECTIVE To vali date the technique of sleep nasendoscopy using target controlled infusion in symptomatic patients and a control group of asymptomatic individuals . DESIGN Prospect i ve coh 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of the present study was to compare pharyngeal and polysomnographical findings during drug-induced sleep endoscopy ( DISE ) performed with either propofol or midazolam as a single sedative agent . It is prospect i ve , non-r and omized , double-blinded case series study . Sixteen patients with sleep disordered breathing were se date d first with propofol and after full wake up with midazolam . Simultaneous polysomnography ( PSG )  was performed . We compared the zones of obstruction and vibration found with both drugs using the VOTE classification . Simultaneous PSG findings are also compared . There were 15 men and one woman ; the mean age was 42.7 years old , mean body mass index 26.9 kg/m2 .  Average DISE duration was 20 min with Propofol and 14.3 min with Midazolam . The induced sleep stage obtained was N2 with both drugs . Outpatient physical exam did not correlate with drug-induced sleep findings . There was a good correlation between DISE results with both drugs in all the areas of collapse except the velum ( p < 0.005 ) . Using a continuous perfusion , there is a good agreement in the findings observed in DISE performed with propofol and midazolam and PSG Objective : To determine the test-retest reliability of drug-induced sleep endoscopy ( DISE ) . Methods : Prospect i ve cohort study . Patients with OSA underwent two separate DISE examinations . The following outcomes were measured : a global assessment of obstruction at the palate and /or hypopharynx ; the degree of obstruction at the palate and hypopharynx ; and the contribution of individual structures ( palate , tonsils , tongue , epiglottis , and lateral pharyngeal walls ) to obstruction . Results : Thirty-two patients underwent two separate DISE examinations . The preoperative sleep study apnea-hypopnea index was 40.7 ± 21.1 , and the lowest oxygen saturation was 79.8 ± 17.4 percent . Point estimates for the intraclass correlation coefficient analogs related to palatal obstruction ranged from 0.41 to 0.89 ; related to the hypopharyngeal airway , the point estimates ranged from 0.57 to 0.84 . Conclusion : The test-retest reliability of DISE appears good , especially in the evaluation of the hypopharyngeal airway . Larger studies can generate more precise confidence interval estimates and test the generalizability of these findings Purpose Several studies have demonstrated the validity , reliability , and safety of drug-induced sedation endoscopy ( DISE ) in assessing the collapse of the upper airway ( UA ) in patients with obstructive sleep apnea hypoapnea syndrome ( OSAHS ) . The aim of this study was to assess the interobserver agreement on DISE and on therapeutic decision between an expert observer and an observer in training . Methods This was a cross-sectional study . Thirty-one DISE videos performed in our service were r and omly selected . Videos belonged to patients with OSAHS who wanted alternative treatments to CPAP .  The videos were review ed by an ENT experienced on DISE and a second observer in formation . Each observer independently assessed the presence of collapse of the UA according to a modified VOTE classification and proposed an alternative treatment to CPAP . Interobserver agreement kappa values were calculated . Results In assessing the presence of collapse at different levels of the upper airway , the percentage of agreement was 80 % at the level of the soft palate ( kappa = 0.1667 ) , 89.29 % in the oropharynx ( k = 0.7742 ) , 80.65 % at the tongue base ( k = 0.5571 ) , and 74.17 % at the epiglottis ( k = 0.4768 ) . When degree and configuration of the collapse was evaluated , the interrater agreement was moderate to good , except at the level of the tongue base where the agreement was weak for both degree and configuration of collapse ( k = 0.34 and 0.38 , respectively ) . Interobserver agreement was moderate when the indication of alternative treatments to CPAP is valued based on the findings of DISE . Conclusions Overall , DISE is a reliable technique even when assessing interobserver agreement between an experienced observer and one in training ; however , tongue base is the level of the upper airway that presents the greatest difficulties when assessing the collapse with DISE . Therefore , it is important to develop learning curves for this technique in order to obtain more reliable results Bispectral  index ( BIS ) monitor is a neurophysiological monitoring device which continually analyses a patient ’s electroencephalogram during sedation and general anaesthesia to assess the level of consciousness and depth of anaesthesia . BIS monitoring , whilst performing sleep nasendoscopy ( using midazolam and propofol ) , has helped vali date depth of sedation and allowed comparison with levels of sedation of control patients during natural sleep . A prospect i ve study of 30 patients with snoring undergoing sleep nasendoscopy with BIS monitoring was conducted .  BIS monitoring was recorded throughout the procedure and assessment of snoring was made at the appropriate level of sedation and snoring . BIS values were compared with control patients . The 30 patients undergoing sleep  nasendoscopy had average BIS values ranging from 50.72 to 61.2 . Similar results were seen with BIS and oxygen saturation in the control group . BIS monitoring provides an adjunct to the assessment of sleep nasendoscopy in determining the level of sedation required for snoring assessment . Comparable BIS values and oxygen saturation levels were obtained between controls and patients during sedation-induced sleep , thus validating the role of sleep nasendoscopy Patients with the sleep apnoea/hypopnoea syndrome ( SAHS ) have impaired daytime function with demonstrable sleepiness and impaired cognition . The hypothesis that brief arousals from sleep cause these daytime impairments was tested . One hundred and fifty patients with sleep disordered breathing were studied prospect ively , comparing  overnight polysomnography  with daytime measures of objective sleepiness , psychological well-being and cognitive performance . Significant , but weak ( r2<0.1 ) , relationships were seen between several nocturnal measures ( apnoea/hypopnoea index , arousals and desaturation variables ) and daytime measures of quality of life , well-being , subjective sleepiness , symptoms and cognitive performance . The only significant relationship between nocturnal variables and objective sleepiness was a very weak correlation ( r2<0.05 ) between the lowest oxygen saturation and mean maintenance of wakefulness test ( MWT ) result . The MWT was better correlated with daytime function than the multiple sleep latency test . This study shows a lack of strong relationships between conventional nocturnal measures and daytime function in patients with sleep disordered breathing OBJECTIVES /HYPOTHESIS This study aim ed to evaluate changes in obstruction site in obstructive sleep apnea ( OSA ) patients according to sleep position . STUDY DESIGN Prospect i ve case series . METHODS Eighty-five patients who had undergone level 1 sleep study and drug-induced sleep endoscopy in the supine and lateral positions were included . Obstruction sites were classified as soft palate ( SP ) , tongue base ( TB ) , lateral wall ( LW ) , and larynx ( LX ) . Subgroup analysis was performed according to lateral apnea-hypopnea index ( AHI ) : those with an AHI of ≥ 10 ( lateral obstructors , LO ) and those with an AHI of < 10 ( lateral nonobstructors , LNO ) . RESULTS Prevalence in obstruction site of SP , TB , and LX decreased significantly after change from supine to lateral position ( P < 0.05 ) . However , the prevalence of LW obstruction was not affected by position change . LW collapse in moderate OSA decreased ( from 66.7 % to 35.9 % ) after change to lateral sleep , whereas it persisted in severe OSA patients ( 81.6%-89.5 % ) . In the lateral position , persistent obstruction at the LW was observed more frequently in the LO group compared to the LNO group ( 83.3 % vs. 33.3 % ) . CONCLUSION When sleep posture is changed from supine to lateral , obstruction due to structures such as tongue base and larynx improves dramatically . Obstruction in lateral position is mostly due to obstruction at the oropharyngeal LWs . Therefore , position dependency is mostly determined by LW collapsibility . Evaluating the changes of the upper airway according to sleep position can further characterize the upper airway collapsibility and can be used for tailored treatment planning OBJECTIVES /HYPOTHESIS The aim of this study is to quantify the correlation between a large tongue classified by the modified Mallampati score ( MMS ) and obstruction at the tongue base observed during sleep endoscopy in patients with socially unacceptable snoring ( SUS ) and obstructive sleep apnea syndrome ( OSAS ) . STUDY DESIGN Prospect i ve . METHODS One hundred twenty-seven patients with obstructive sleep apnea and SUS underwent sleep endoscopy .  Patients were classified into four specific groups according to their MMS . After intravenous administration of midazolam , obstructive events in the upper airway were classified . The level of obstruction was expressed as palatal ( 2 ) , palatal and to a lesser degree base of the tongue/laryngeal level ( 2 ) , tongue base/laryngeal level and to a lesser degree palatal ( 3 ) , and tongue base/laryngeal level ( 3 ) . The degree of correlation between the level of obstruction and the MMS was analyzed by means of Spearman 's rank-order correlation . RESULTS No linear association between the level of obstruction and MMS could be found . A large tongue ( MMS 3 or 4 ) does not predict obstruction at the base of the tongue . Patients classified as MMS 1 or 2 did not frequently show obstruction at the base of the tongue ( 9 of 38 , 23,6 % ) . The majority of the population showed retropalatal obstruction . A large tongue ( MMS 3 or 4 ) was often accompanied by retropalatal obstruction , 76 % of the cases ( 64 of 89 ) . CONCLUSIONS No positive correlation exists between a large tongue and obstruction at tongue base level . In both groups , retropalatal obstruction occurred more often than retrolingual obstruction .  Sleep endoscopy provides qualitative insight into important changes during sleep in patients with SUS and OSAS . In addition , anatomic aberrations are clearly visualized in a dynamic setting . Classification of the size of the tongue , as assessed by the MMS , may be of great importance as well It has been proposed that sleep nasendoscopy ( SN ) will improve the success rate of the uvulopalatopharyngoplasty operation by identifying those patients with palatal snoring . The aim of this study was to test the efficacy of SN in the management of snorers who do not have obstructive sleep apnoea . This study compared a group of 26 snorers managed without SN ( group A ) to a group of 27 snorers managed with SN ( group B ) . The post-operative results of group A were 61 per cent cured , 27 per cent better and 8 per cent unchanged . Group B results were 76 per cent cured , 19 per cent better and 5 per cent unchanged . However , if patients with only palatal snoring had surgery , the results for group B would have been 94 per cent cured , 6 per cent better and 0 per cent unchanged ( 95 per cent C.I. of difference + 0.14 , + 0.54 , p = 0.017 ) . The results confirm the predictive power of SN in identifying success following  uvulopalatopharyngoplasty .  A simple grading system is suggested to aid in treatment planning . Patients are divided into three categories on SN : palatal snorers , mixed snorers and non-palatal ( tongue base ) snorers . It is proposed that uvulopalatopharyngoplasty may cure palatal snorers but mixed snorers will need additional therapies to eliminate their snoring although uvulopalatopharyngoplasty may improve the symptoms Sixty patients diagnosed with obstructive sleep apnea syndrome ( OSAS ) underwent uvulopalatopharyngoplasty ( UPPP ) .  The effects of surgery were studied based on endoscopic findings during drug-induced sleep and determination of the apnea-hypopnea index ( AHI ) before and after the operation . Changes in the form of the airway during sleep in the recumbent position were observed , and the role of upper airway endoscopy in the diagnosis and surgical treatment of OSAS was determined . The site of airway obstruction during sleep induced by i.v . injection of 10 mg of diazepam was classified into five types , and changes in AHI and the site of airway obstruction were compared before and after surgery . Changes in airway morphology during sleep in the supine and recumbent positions were also compared before surgery . The postoperative improvement rate was 74.4 % for the soft palatal type of obstruction , 76.2 % for the tonsillar type , 53.3 % for the circumferential palatal type and 34.0 % for the mixed type . Treatment produced excellent or good effects for the soft palatal and tonsillar types of obstruction . However , many patients with the circumferential palatal and mixed types of obstruction showed only some improvement or no change . Good airway morphology was maintained in the recumbent position by patients with the soft palatal type of obstruction . With the circumferential palatal and mixed types of obstruction , improvement can be expected from operations which include surgical treatment of the posterior pharyngeal wall or lateral funiculus , or with midline laser glossectomy . A good operative outcome can be predicted in patients showing improvement of apnea in the recumbent position preoperatively OBJECTIVE To vali date the technique of sleep nasendoscopy using target controlled infusion in symptomatic patients and a control group of asymptomatic individuals . DESIGN Prospect i ve coh 
    Output:
    