Discussion
The usefulness of hypnosis in sleep disorders was previously
investigated in pediatric [7,8] and adult [9] populations in the
management of insomnia, acclimatization of noninvasive positive pressure
ventilation or in weight loss of obese OSAS patients. To the best of our
knowledge, this preliminary study is the first investigation reporting
safety and feasibility of HISE in patients with moderate-to-severe OSAS.
In this study, we proposed and evaluated a step-by-step protocol, which
is easy to apply in daily practice.
According to our protocol, most patients adhered to hypnosis (95%),
while the sleep endoscopy was successfully achieved in 95% of cases,
leading to proposition of sleep therapy. HISE is a cost-effective
approach, which is probably its most important advantage. Indeed, the
use of drugs, the occupation of the operating room and the requirement
of the anesthesiologist team are all costs [10] that we may avoided
using HISE. Moreover, HISE may be interesting for patients with drug
contraindication. Our study highlights that the selection of patients is
an important point. Indeed, the adherence to hypnosis requires the lower
level of pain during the examination. In our study, we observed that at
most the nasofibroscopy was difficult to perform (major septal
deviation/turbine hypertrophy), at most the efficacy of hypnosis (level
of consciousness) was low. In that way, it is important to prepare the
patient to the procedure through 3 hypnosis sessions in which
practitioners assess the hypnosis adherence, the stress/anxiety of
patient regarding procedure and the nasal permeability in
nasofibroscopy. The importance of the preparation to HISE was
strengthened by the significant positive associations between the level
of difficulty to perform nasofibroscopy, the possibility to adequately
perform the VOTE scoring, the levels of patient stress during HISE and
trance.
This study is a feasibility study, meaning that we aimed to explore the
feasibility and safety of HISE before conducting controlled large-cohort
investigation. Indeed, the main limitation of the present preliminary
report is the lack of control group (cross-over study), and the lack of
brain monitoring (BIS system), which is important to observe the effects
of anesthetic or alternative sedative approaches on cerebral function.
Moreover, the HISE involves the participation of an experienced hypnosis
practitioner, who has a key role in the success of the procedure.