Effectiveness of drug-induced sleep endoscopy in improving outcomes of barbed pharyngoplasty for obstructive sleep apnea surgery: a prospective randomized trial

Abstract

Purpose To observe the effectiveness of preoperative drug-induced sleep endoscopy in improving surgical results of patients undergoing single-level barbed pharyngoplasty surgery for OSA, using a prospective randomized model. Methods A single-center randomized controlled trial with two prospective arms was carried out to compare functional results in patients treated with barbed reposition pharyngoplasty (BRP) surgery without a preoperative drug-induced sleep endoscopy (DISE) evaluation vs patients treated with BRP surgery performed after DISE evaluation of sites/patterns of collapse. ResultsWe compared 50 patients who underwent BRP without a preoperative DISE evaluation (Group A) and 42 patients (Group B) treated with BRP surgery but preoperatively selected by means of a preoperative DISE. In this second group of patients, after DISE evaluation, 70% of patients were selected for single-level BRP surgery because they showed an isolated velopharyngeal collapse at the DISE evaluation, without obstruction at other upper airway levels evaluated. Both groups of patients showed a statistically significant difference between preoperative and postoperative values of AHI, ODI, and LOS (p<0.05 in all cases). Comparing Group A and Group B patients, the therapeutic success rate was found to be 60% in patients treated without preoperative DISE evaluation and 83% in patients treated with preoperative DISE (p = 0.02). Conclusion DISE appears to improve the surgical results of single-level velopharyngeal surgery due to the possibility of excluding patients with obstruction of the base of the tongue, the hypopharynx, and the epiglottis/larynx.

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

“…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. After reviewing the bibliography of the considered studies, no additional article was included.…”

“…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.…”

“…Six articles reported success rates, representing 465 patients (219 in the DISE group and 246 in the no DISE group). 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).…”

The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea

“…Kezirian EJ applied DISE to observe the post-surgical UA collapse features in 33 individuals with uvulopalatopharyngoplasty(UPPP) failure and found that 45% of patients still had complete retropalatal collapse and 79% of patients had complete hypopharyngeal obstruction, confirming that residual palatal and glossal obstruction were important factors affecting the efficacy of UPPP [ 48 ]. Based on preoperative DISE assessment, surgeons could identify isolated velopharyngeal obstruction from combined velopharyngeal-hypopharyngeal obstruction, increasing the success rate of modified barbed pharyngoplasty from 60% to 83% [ 49 ]. In a study comparing two OSA cohorts with similar demographics and sleep test outcomes, compared with the group without pre-surgical DISE, preoperative DISE not only improved surgical success rate (86% vs 51%), but also decreased the proportion of multilevel surgeries (8% Vs 60%), that actually reduced unnecessary surgical damage and the risk of complications [ 50 ].…”

Impact of Upper Airway Characteristics on Disease Severity and CPAP Therapy in Chinese Patients With OSA: An Observational Retrospective Study

“…There are mainly three methods of endoscopy evaluation: awake electronic endoscopy, drug-induced sleep endoscopy (DISE), and natural sleep endoscopy. Drug-induced sleep laryngoscopy represents the gold standard for the diagnosis of obstructive site (9) and is often used for preoperative evaluation in ear, nose and throat (ENT) surgeries (10). However, it carries some risk due to the drugs, requires closer monitoring, and is more complex and expensive.…”