Drug-Induced Sleep Endoscopy: Technique, Indications, Tips and Pitfalls

Carrasco-Llatas, Marina; Matarredona-Quiles, Silvia; Vito, Andrea De; Chong, Khai Beng; Vicini, Claudio

doi:10.3390/healthcare7030093

Cited by 24 publications

(13 citation statements)

References 33 publications

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“…Propofol has consistently established itself as the gold standard for sedation in this setting as it combines overall safety and time effectiveness. Moreover, several studies have shown that findings in DISE tests conducted under propofol sedation led to appropriate surgical outcomes [11,12] . Propofol can be administered in boluses or as an infusion.…”

Section: Discussionmentioning

confidence: 99%

A single-center pilot study comparing dexmedetomidine continuous infusion versus propofol TCI for drug-induced sleep endoscopy (DISE)

Alicino¹,

Corso²,

Barbara³

et al. 2021

JOHNA

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Background: Drug-induced sleep endoscopy (DISE) has become a routine diagnostic tool to assess the upper airway in obstructive sleep apnea patients, enabling effective diagnosis and appropriate treatment of the obstruction site. A number of protocols with different drugs and availability of target-controlled infusion (TCI) systems have been reported and published, making comparisons between studies difficult. In recent years, dexmedetomidine has claimed a role as a potential alternative to propofol for DISE sedation. In a real-life study we compared the effects of dexmedetomidine continuous infusion or propofol-TCI in patients undergoing DISE on time to reach adequate observation conditions, cardio-respiratory parameters, and recovery. Methods: Pilot prospective, randomized not blinded, single center study. A total of 28 patients scheduled to have DISE were randomly assigned to either group P (N=14; propofol-TCI, initial propofol effect-site target concentration 2.0 µg/mL, increased by 0.3 µg/mL every 2 min) or group D (N=14; dexmedetomidine bolus 1 µg/kg over 10 min, followed by infusion at 0.7 µg/kg/h). Hemodynamic and respiratory variables (including SpO2 nadir), time to reach the observation window and overall DISE duration were recorded. Results: A total of 28 patients were enrolled and completed the study: the cohort included 26 males (92.85%) and 2 females (7.14%). The mean age was 45.4±11.1 years [interquartile (IQ), 25.0–65.0], body mass index 30.5±3.4 kg/m2 (IQ, 21.0–36.0), and apnea-hypopnea index 36.9±21.1 events/hour (IQ, 7.8–95.0). There were no statistically significant differences between the 2 groups in baseline apnea-hypopnea index, oxygen desaturation index, Epworth Sleepiness Scale score, preprocedural SpO2 nadir, age, sex, or body mass index. Compared with group P, group D showed significant differences in SpO2 (higher nadir during DISE, 87.09±5.4% vs. 75.0±11.0; P<0.001) and heart rate (80.4±8.9 vs. 62.8±6.6; P<0.001). While group D had longer duration of endoscopic examination times and emergence time from sedation, the grading of site of obstructions were similar in the 2 groups. Conclusions: Dexmedetomidine seems a limited, if viable, clinical alternative for DISE when propofol is contraindicated or not available: while causing higher SpO2 nadirs compared with propofol, it has a slow onset and longer recovery time, increasing total procedural time. Studies with greater patient numbers are needed to confirm these observations.

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Section: Discussionmentioning

confidence: 99%

A single-center pilot study comparing dexmedetomidine continuous infusion versus propofol TCI for drug-induced sleep endoscopy (DISE)

Alicino¹,

Corso²,

Barbara³

et al. 2021

JOHNA

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show abstract

“…However, if the patient does not tolerate CPAP, DISE can be utilized to determine the possible effectiveness of alternative treatments including upper airway surgery and oral devices. DISE cannot be safely performed in patients with American Society of Anesthesiologists class 4, pregnancy, or allergies to sedative agents [17]. A high apnea-hypopnea index (AHI) score is not considered as a contraindication for DISE [17].…”

Section: Clinical Applicationmentioning

confidence: 99%

“…DISE cannot be safely performed in patients with American Society of Anesthesiologists class 4, pregnancy, or allergies to sedative agents [17]. A high apnea-hypopnea index (AHI) score is not considered as a contraindication for DISE [17].…”

Section: Clinical Applicationmentioning

confidence: 99%

Drug-Induced Sleep Endoscopy: A Guide for Treatment Selection

et al. 2020

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Identifying the sites, severity, and pattern of upper airway obstruction in obstructive sleep apnea is crucial for determining the treatment options, particularly the surgical plan. Although early methods of assessment, such as Muller's maneuver, computed tomography, and magnetic resonance imaging in awake patients have been utilized to assess obstructive sites, the physiologic and anatomical differences between awake and sleeping patients showed a limited ability of those methods as diagnostic tools. Recently, drug-induced sleep endoscopy (DISE) was introduced as a useful diagnostic and evaluation tool to identify dynamic upper airway collapse during sedation that simulates natural sleep. In this article, we review all aspects of DISE, including the technique, evaluation methods, and clinical application.

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“…This test may allow treatment customizing based on the respective obstruction site and pattern, positively impacting the outcome 14 , 15 . However, DISE requires standardization to obtain reliable information, which depends on the used sedation protocol 16 , encouraging the search for easier methods to predict the site and type of UA collapse.…”

Section: Introductionmentioning

confidence: 99%

Myofunctional assessment for obstructive sleep apnea and the association with patterns of upper airway collapse: a preliminary study

Kayamori¹,

Rabelo²,

Nazario³

et al. 2022

Sleep Sci

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Objectives To organize an assessment instrument with questionnaires and myofunctional orofacial/oropharyngeal assessment for OSA patients and correlate it with the upper airway obstructive site detected during drug-induced sleep endoscopy (DISE). Material and Methods 29 OSA patients aged 22-65 years with an indication to undergo DISE to evaluate an alternative treatment to PAP and signed the consent form. Patients over 65 years old with maxillofacial deficiency and BMI>30 were excluded. The subjects answered the Pittsburgh, Berlin (snore), and Epworth questionnaires. The myofunctional orofacial/oropharyngeal assessment comprised soft palate, palatine pillars, and uvula (structure and mobility), tonsils (size), mandible (bony bases), hard palate (depth and width), tongue (posture, volume, width, and height), floor of mouth (mylohyoid), tongue suction and sustaining (mobility), “lowering of the back of the tongue” (stimulus), which were scored by three speech-language pathologists with expertise. DISE was scored according to VOTE classification. The statistical analysis (t-test) compared groups without and with obstruction in VOTE with questionnaires and myofunctional orofacial/oropharyngeal assessment. Results The following were significantly different: snoring frequency (p=0.03) with VOTE/velopharynx; intensity (p=0.02) and frequency of snoring (p=0.03) with VOTE/lateral wall of oropharynx; suction the tongue and sustain (p=0.02) with VOTE/velopharynx; hard palate depth (p=0.02) and width (p=0.05) with obstruction VOTE/epiglottis; tonsils volume (p=0.05) with VOTE/epiglottis; tongue posture (p=0.00) with obstruction VOTE/epiglottis; floor of the mouth (p=0.02) with VOTE/epiglottis. Conclusion Higher snoring frequency and intensity was observed in patients with obstruction at the velopharynx and oropharyngeal lateral wall. Obstruction at the velopharynx was associated with poor tongue ability to suck the tongue against the hard palate. Obstruction at the epiglottis had structural and functional associations, including the oropharyngeal lateral wall, affected by the palatine tonsils size, depth and width of the hard palate, tongue position, and flaccidity of the floor of mouth. Considering that this is a preliminary study, the data should be carefully verified and not generalized.

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Drug-Induced Sleep Endoscopy: Technique, Indications, Tips and Pitfalls

Cited by 24 publications

References 33 publications

A single-center pilot study comparing dexmedetomidine continuous infusion versus propofol TCI for drug-induced sleep endoscopy (DISE)

A single-center pilot study comparing dexmedetomidine continuous infusion versus propofol TCI for drug-induced sleep endoscopy (DISE)

Drug-Induced Sleep Endoscopy: A Guide for Treatment Selection

Myofunctional assessment for obstructive sleep apnea and the association with patterns of upper airway collapse: a preliminary study

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