Sleep video endoscopy

What is a sleep endoscopy and for what is it used?

Propofol-induced sleep endoscopy (somnoendoscopy) with simultaneous monitoring of the depth of sleep while determining brainwaves (EEG) and the use of a computer-controlled medication pump enables localisation of the anatomical collapse of the respiratory tract during sleep. The aim is to localise the exact point at which vibrations occur on the mucous membranes or soft tissue structures as well as to find bottlenecks in the respiratory tract. This allows doctors to determine the mechanism which is responsible for the snoring. The patient is put into a deep sleep state during the process. Alongside REM sleep, which unfortunately cannot be generated using artificial means, sleep states III and IV are particularly significant. In these sleep states, the basic tension of the musculature drops significantly, the musculature goes to sleep. The typical nocturnal symptoms occur and the patient affected begins to snore.

A flexible video endoscope (nasopharyngoscope) with a microphone is then inserted through the nose. The endoscope has a diameter of only three millimetres. Thanks to its length, it can be guided through the nose via the nasopharynx, oral cavity and throat to the larynx and offers a precise panorama (360°).  Thus, anatomical peculiarities and bottlenecks can be inspected. Depending on the individual incidence, various forms of snoring can be made visible and audible.

The various forms of snoring may also influence each other or alternate. Various forms of snoring frequently occur in one and the same patient either simultaneously or consecutively. The snoring can change or even stop as a result of changing the position of the body or moving the lower jaw forwards during the sleep endoscopy. It is also possible to record and display complete breathing stops, as they occur in obstructive sleep apnoea syndrome. 

In this way, the complex picture of snoring sounds and/or nocturnal breathing stops can be individually visualised and analysed very precisely. Consequently, the countermeasures and their chances of success can be determined. 

In many cases, a snoring operation, which has previously been discussed, is carried out directly after the sleep endoscopy. Having emerged from the deep sleep phase, the patient is immediately placed under anaesthetic without waking in between.

A sleep endoscopy is an ambulant and completely pain-free test. After a preliminary discussion with the sleep doctor, the patient is “hooked up”and put into an artificial sleep state similar to anaesthesia.
The doctor then begins thoroughly investigating the upper respiratory tract (nose, throat, larynx and pharynx) using the thin and flexible endoscope. This allows for a comprehensive inspection of the breathing functionality as well as the anatomical structures of the patients’ upper respiratory tract.

The artificial sleep is controlled in such a way that the patient wakes up again quickly after the test. A sleep endoscopy generally only takes half an hour. After a short waking period, the patient may leave the practice. However, for legal and safety-related reasons, they must be accompanied. No pain occurs during the sleep endoscopy.
When is a sleep endoscopy useful and what are the chances of success?

An extensive ENT and sleep medicine test is advisable in cases of typical signs of sleep disturbances and snoring. Alongside polygraph screening, this also comprises a sleep endoscopy. The combination of these two tests enables a very precise diagnosis in order to determine the exact location of origin of the snoring and the scale of the narrowing and thus the breathing stops and the stresses on the cardiovascular system.