1. How did you get envolved in OSA field?
I am involved in research about OSA pathophysiology, diagnosis and treatment and clinical aspects in daily routine.
2. How is this work in conjunction with your speciality training?
No specific training was organized at the time of my residency. During my training I had the opportunity to visit The Sleep Center of Stanford University, California, and I built up my knowledge thanks to my mentor Prof Vicini.
3. How do you see ideal collaboration between doctors of surgical and non-surgical specialities?
Multidisciplinary clinical approach and multimodality treatment is of pivotal importance for OSA patients
4. What kind of problems you encounter at your practice?
The dialogue between the different specialities involved with the OSA patients
5. How do you see OSA diagnostic and treatment in the future?
The diagnosis of OSA will be able to improve for new mathematical algorithms for evaluation of sleep studies, moreover in highlighting non anatomical pathophysiological factors, such as loop gain and arousal threshold. The treatment of OSA will be able to take advantage of new forms of neural stimulation, new surgical mini invasive techniques and myofunctional therapy.
6. Can you name an article or two that you have read recently and have influenced your understanding of OSA diagnostics and treatment?
– Arganbright JM, Lee JC, Weatherly RA. Pediatric drug-induced sleep endoscopy: An updated review of the literature. World J Otorhinolaryngol Head Neck Surg. 2021 Jun 29;7(3):221-227. doi: 10.1016/j.wjorl.2021.05.002. PMID: 34430829; PMCID: PMC8356111.
– Osman AM, Carter SG, Carberry JC, Eckert DJ. Obstructive sleep apnea: current perspectives. Nat Sci Sleep. 2018 Jan 23;10:21-34. doi: 10.2147/NSS.S124657. PMID: 29416383; PMCID: PMC5789079.
7. How do you see the role of DISE in the OSA diagnostic process?
There are numerous techniques available to assess the pharyngeal collapse and/or obstruction during apnoeas/hypopneas events in OSA patients, including imaging, acoustic analysis, pressure transducer recording and endoscopic evaluation. It is essential to note that the nocturnal obstructive events are characterized by sleep-related decreasing muscular tone. Thus, the evaluation of the upper airway during awake conditions could be limited and not related to sleep breathing disorders. Drug induced sleep endoscopy (DISE) was introduced in 1990. The nomenclature and the technique has been modified by various institutions over the years, but the core value of this evaluation technique remains similar and extremely useful for identifying the anatomical segment responsible for obstructing the upper airway during sleep in patients with sleep related breathing disorders. There have been numerous controversies that have surrounded this technique but over the last two decades most of these have been addressed and it remains in the forefront of methods for the diagnostic and treatment decision making process in OSA patients.