Systematic Review of Drug‐Induced Sleep Endoscopy Scoring Systems

Abstract

Objective To systematically review the scoring systems used to report findings during drug-induced sleep endoscopy (DISE) for adults and children with obstructive sleep apnea. Data Sources PubMed, CINAHL, EBM Reviews, Embase, and Scopus databases. Review Methods This is a systematic review of all indexed years of publications referring to scoring of DISE for children and adults with obstructive sleep apnea. The type of DISE scoring system utilized was the primary outcome. PRISMA guidelines were followed to carry out this review; articles were independently reviewed by 2 investigators. All pediatric and adult studies that utilized ≥1 DISE grading systems were included. Results Of 492 identified abstracts, 44 articles (combined population, N = 5784) were ultimately included; 6 reported on children, 35 on adults, and 1 on children and adults. Twenty-one reporting methods were used in these studies, with the most common being the VOTE system (velum, oropharynx, tongue base, and epiglottis; 38.6%) and the Pringle and Croft classification (15.9%). The sites of obstruction most commonly included in a scoring system were the tongue base (62%), lateral pharynx/oropharynx (57%), palate (57%), epiglottis/supraglottis (38%), and hypopharynx (38%). Less commonly included sites were the larynx (29%), velum (23%), nose (23%), tongue (14%), adenoids (10%), and nasopharynx (10%). Conclusion There is no consensus regarding which scoring system should be utilized to report findings during DISE. The VOTE system and the Pringle and Croft classification were the most frequent scoring systems reported for patients undergoing DISE. Standardization of the reporting of DISE findings would improve comparability among studies.

Comparative assessment of drug‐induced sleep endoscopy scoring systems in pediatric sleep apnea

“…A presurgical DISE could help to identify children at risk for residual OSA, and a scoring system that can aid in identifying these children would vastly improve the management of children with OSA. A systematic review of DISE scoring systems used in adults and children with OSA revealed no consensus regarding which scoring system should be utilized to report findings during DISE for adult and children with OSA . Standardization of DISE findings would be useful to improve comparability among studies and improve the quality of outcomes research for sleep surgery .…”

“…8 Standardization of DISE findings would be useful to improve comparability among studies and improve the quality of outcomes research for sleep surgery. 8 We evaluated the utility of DISE scoring systems in the assessment of OSA using a single cohort of pediatric patients.…”

“…DISE is utilized to identify the sites of airway obstruction during sleep, formulate treatment decisions, and plan surgical treatment in children and adults with obstructive sleep apnea (OSA) . A wide variety of scoring systems is available to report and analyze DISE . The majority of DISE scoring systems have been developed for adults with OSA.…”

“…DISE scoring systems for adults often do not include commonly known sites of obstruction in children with OSA, such as the nasopharynx or the larynx. DISE scoring systems have a high degree of variability in the anatomical sites included in the scoring systems . The assessment of the severity and the configuration of the obstruction is also variable and often not a part of the DISE scoring at all .…”

“…[2][3][4][5][6][7] A wide variety of scoring systems is available to report and analyze DISE. 8 The majority of DISE scoring systems have been developed for adults with OSA. DISE scoring systems for adults often do not include commonly known sites of obstruction in children with OSA, such as the nasopharynx or the larynx.…”