European position paper on drug-induced sedation endoscopy (DISE)

Abstract

Methods: The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique.Background: Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting.Results: A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the terminology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied sedation drugs and observation windows. Otherwise, no consensus has been reached on a scoring and classification system.Conclusions: Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking

Effect of upper-airway stimulation for obstructive sleep apnoea on airway dimensions

“…After awake endoscopy, with the patient still in the supine position, propofol and/or midazolam were administered as sedatives [19]. DISE was performed in the same manner as the pre-implant screening, following the study's DISE protocol.…”

“…DISE was performed in the same manner as the pre-implant screening, following the study's DISE protocol. The targeted sedation depth was a loss of response to verbal stimulation and the presence of snoring and/or obstructed airway events [19]. When the sedation target was achieved, the endoscope was inserted distally to visualise the nasopharyngeal, retropalatal, oropharyngeal, retrolingual and retroepiglottic regions, and assess the baseline direction and degree of upper-airway collapse over several respiratory cycles during inspiration using a standardised protocol [15].…”

“…Variability during DISE assessment may occur due to differences in sedation depth during the procedure or between patients, which may influence collapsibility. In our study, the DISE procedure was set by protocol, with a sedation depth target of loss of verbal response to stimuli, and the presence of snoring and/or sleep apnoea events [19]. While our approach was based on visual symptoms of airway obstruction, quantitative methods for measuring DISE sedation depth via electroencephalography have also been suggested [34].…”

“…The latter technique is a widely used method to determine the degree, configuration and site of upper-airway obstruction when selecting patients for non-CPAP treatments for OSA [19]. DISE offers a method to visually quantify upper-airway changes during sedation, which has been shown to simulate upper-airway collapse during sleep [20,21].…”

Organization and logistics of drug-induced sleep endoscopy in a training hospital

“…Clinical and scientific interest in DISE is growing-e.g., in the past 2 years, the number of scientific publications on DISE is equal to the number of publications from all years prior [1].…”