Advances in the Role of Drug-Induced Sleep Endoscopy in Investigating Sleep Apnea

Abstract

Purpose of Review

Our aim is to highlight the current advances and the role of drug-induced sleep endoscopy (DISE) in investigating sleep apnea.

Recent Findings

Since drug-induced sleep is not necessarily identical to natural sleep, proper level of sedation is important. When using propofol, clinically useful determinations of airway obstruction seem to occur at medium sedation, which is most probably achieved with a blood propofol concentration of 3.2 μg/ml. Historically, recommendations were to perform DISE in the worse sleeping position, which is almost always the supine position. In positional dependent obstructive sleep apnea (POSA), evaluation of the upper airway in lateral position becomes more important and can be mimicked by lateral head rotation alone. Simulation bites and systems as the matrix provide higher accuracy to simulate the possible effect of oral appliance therapy (OAT) compared to manual jaw thrust. When evaluating awake examination versus DISE for surgical decision making, a modification was made in 50% after DISE. Multilevel surgery was performed less after preoperative DISE screening (8 versus 59.5%) and surgical success rate was increased (86 versus 51.4%).

Summary

Drug-induced sleep endoscopy can be used for assessment of the upper airway in patients diagnosed with OSA and is essential to determine site-specific treatment and individual patient management. Management of OSA is slowly moving away from CPAP treatment only, and evidence is rising that assessment with DISE changes surgical and non-surgical treatment planning and increases treatment outcome.

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