Comparison of surgical outcomes of sleep surgeries preoperatively evaluated with drug-induced sleep endoscopy and Müller's maneuver

Chen, Rong-Feng; Nakayama, Meiho; Sung, Wei-Che; Hung, Jeng-Fung; Chu, Yih-Min

doi:10.1016/j.anl.2021.08.001

Cited by 4 publications

(12 citation statements)

References 31 publications

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“…The mean difference between 'DISE' versus 'no DISE' groups was not significant in three studies. 17,19,20 A significant difference was found in favour of the 'no DISE' group in one study (a greater reduction of 3.8 events/hour compared to the 'DISE group') 10 and a significant difference in favour of the 'DISE group' was found in another study (greater reduction of AHI of 6.8…”

Section: Apnea-hypopnea Indexmentioning

confidence: 94%

“…As illustrated in the flow chart (Figure 1), 619 articles were identified, of which 137 were neither a cohort study nor a randomised trial. Of the 482 remaining articles, 7 were included in the meta-analysis, including six observational studies 10,[17][18][19][20][21] and one randomised trial. 22 These seven articles represent 791 patients, 389 in the DISE group and 402 in the no DISE group.…”

Section: Study Selectionmentioning

confidence: 99%

“…DISE was performed with propofol alone in four studies, 17,18,20,21 with various drugs in another (propofol alone, propofol + remifentanil or dexmetidine + remifentanil) 19 and one centre included in the multicentric study from Pang et al performed dexometidine-DISE. 10 The VOTE classification 23 was used in five studies, 10,17,19,20,22 a VOTE-adapted classification was used in one study, 21 and the classification system used was not described in the last study. 18 In all studies, surgery followed a previous treatment (PAP and/or mandibular advancement device) that failed or was not tolerated.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In five articles, 17,[19][20][21][22] success was defined according to the Sher's criteria (a decrease in AHI >50% and AHI <20 events/hour) 24 and one used a slightly modified definition of success rate (a decrease in AHI >50% and AHI <15 events/hour). 18 Four articles reported non-significant associations between DISE and success rate, [17][18][19]21 and two found a significant association between DISE and success rate (OR 4.42 and 3.33, corresponding 95% CI being 1.09-18.0 and 1.24-8.96). 20,22 As presented in Figure 2,…”

Section: Success Ratementioning

confidence: 99%

“…Five articles reported changes in AHI, pre and postoperatively according to the realisation or not of a pre-operative DISE. 10,17,19,20,22 They represented 614 patients overall, 302 in the DISE group and 312 in the no DISE group. In all studies, mean postoperative AHI was lowered, reductions ranging from À8 to À25.7 events/hour compared to preoperative AHI.…”

Section: Apnea-hypopnea Indexmentioning

confidence: 99%

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Is drug‐induced sleep endoscopy associated with better outcomes after soft tissue surgery for sleep apnea? A systematic review and meta‐analysis

Lisan

Baudouin

Lechien

et al. 2022

Clinical Otolaryngology

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Objectives The aim was to estimate the effect of drug‐induced sleep endoscopy (DISE) on surgical outcomes after soft tissue surgery for obstructive sleep apnea (OSA). Design and Setting Systematic review and meta‐analysis. Participants Adult patients with OSA and candidates for soft tissue surgery, with and without preoperative DISE, were included. Main Outcomes Measures A systematic literature search of Medline, Web of Science, and Cochrane databases was performed from inception to December 31, 2021. Studies directly comparing patients with and without preoperative DISE were included. Success rate, change in apnea‐hypopnea index (AHI), change in minimum SpO2 and change in Epworth Sleepiness Scale (ESS) score were extracted. Random‐effect models were used to pool estimates. Results Seven out of 619 articles were included, representing 791 patients (389 in the DISE group and 402 in the no DISE group). DISE was neither associated with a higher success rate (pooled OR 1.34, 95% CI 0.69–2.59, p = 0.39) after soft tissue surgery for OSA, nor a significant change in AHI (−4.69 events/hour, 95% CI −11.10 to 1.72, p = 0.15), minimal SpO2 (mean increase of 2.02%, 95% CI −0.26 to 4.29, p = 0.08) and ESS (mean difference of 1.29, 95% CI −0.48 to 3.05, p = 0.15) when compared to patients without preoperative DISE. Conclusions Soft tissue surgery does not give better results after DISE compared to when DISE is not performed. However, given the overall low level of evidence of included studies, future well‐conducted studies should confirm or overturn these results and clarify the added value of DISE.

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