Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea

Abstract

The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n = 17, 33.3%), followed by palatal and oropharyngeal collapse (n = 12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

Impact of continuous positive airway pressure in patients with obstructive sleep apnea during drug‐induced sleep endoscopy

“…The authors noted that two of these patients required a CPAP pressure of 12 hPa (12 cm H 2 O) and one required 18 hPa (18 cm H 2 O) to open the upper airway. When lower pressures were applied, the epiglottis was pushed down into the endolarynx …”

The Impact of Drug-induced Sleep Endoscopy on Therapeutic Decisions in Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

“…In adults, detailed descriptions of changes in surgical sites were provided in five studies among 231 patients [9,13-16]. The changed recommendations by DISE were frequent in the epiglottis (42.9%) and the soft palate (39.8%).…”

Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review

“…In children with persistent moderate-to-severe OSA following AT, or those with small tonsils, or unable to tolerate CPAP, a drug-induced sleep endoscopy (DISE) can be performed to assess for other sites of obstruction [ 45 ]. In this procedure, a patient is brought to the OR and put to sleep with general anesthesia to mimic night-time sleep.…”