Drug-Induced Sleep Endoscopy: Clinical Application and Surgical Outcomes

Abstract

The visualization of the level and pattern of apnea and hypopnea events is of pivotal importance in the diagnosis and therapeutic decision-making for sleep-disordered breathing (SDB). There are numerous techniques available to assess upper airway obstruction, which include imaging, acoustic analysis, pressure transducer recording, and endoscopic evaluation. Drug-induced sleep endoscopy (DISE) is a diagnostic tool that allows the dynamic, three-dimensional evaluation of the patterns of vibration and collapse of the upper airway of SDB patients. DISE may change the initial surgical planning in a high percentage of cases. A universally accepted and methodologically standardized DISE could provide significant insight into its role to improve surgical outcomes. However, up to now the ideal DISE protocol remains an open question.

Ankyloglossia in Children, a Cause of Obstructive Sleep Apnoea: Case Report of Paediatric Ankyloglossia and Sleep Apnoea: DISE Resolves the Mystery

“…We believe this technique of DISE-frenotomy-DISE is a useful procedure to assure the benefits of surgery, allowing for an evaluation of further complementary treatments if required. Furthermore, this technique increases adherence to MFT, providing the patient with visual feedback about the anatomical reasons for their disease [8]. We are considering the predictive factors involved in this procedure's success as we know that not all patients with Ankyloglossia are candidates for this procedure.…”

“…Up to now, there is no case reported in a paediatric OSA patient showing anatomic changes after a therapeutical intervention. DISE is commonly used to explain anatomical findings in OSA patients without a reasonable explanation of their disease [7] and, in our experience, also to improve adherence to myofunctional therapy [8,9]. We introduce the first OSA paediatric case, where Ankyloglossia surgery combined with MT resolves the disease, demonstrated by DISE performed pre-and postoperatively.…”

“…This measure was considered normal if the difference between the two was <50%. Our protocol functional assessment [8] included measurements with the Iowa Oral Performance Instrument (IOPI), and our results were maximum tongue strength 36 kilopascal (Kps) (normal 65 Kps) and maximum buccinator strength 24 Kps (normal 35 Kps).…”

Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices

“…Many authors [ 8 , 9 ] consider drug-induced sleep endoscopy (DISE) an optimal diagnostic test for evaluating the validity of MAD therapy. DISE allows direct visualization of obstruction sites and collapse patterns in patients affected by snoring or OSA and can be useful to discriminate those who would benefit from MAD therapy.…”