Drug-induced sleep endoscopy (DISE) for non-CPAP treatment selection in patients with sleep-disordered breathing

Excerpt

The aim of upper airway (UA) evaluation in patients with sleep-disordered breathing (SDB) is not only to gain a better insight into the complex pathophysiology of UA collapse but also to improve treatment success rates while prospectively selecting the most appropriate therapeutic option for the individual patient [1]. UA assessment in SDB patients is often limited by the fact that the evaluation is static and/or performed during wakefulness, possibly not representing the actual dynamics of UA collapsibility during sleep, while investigations of the UA during natural sleep remain time and manpower consuming [1‐3]. Drug-induced sleep endoscopy (DISE) provides an alternative method of studying the UA while performing a fiberoptic endoscopy during sedation as pharmacologically induced with midazolam and/or propofol [1‐4]. DISE allows to determine the pattern of UA narrowing and obstruction, as part of the therapeutic decision-making process towards UA surgery and/or oral appliance therapy in patients with SDB as there is a high interest in the prospective prediction of non-CPAP treatment outcome [2, 4, 5]. Recent studies have examined the validity as well as the test–retest and interrater reliability of DISE [6‐8]. DISE procedures, however, lack uniformity in the methods used for the drug-induced sedation, while a consensus on DISE classification systems has not been established [3‐5, 9]. …