Comparison of Drug-Induced Sleep Endoscopy and Lateral Cephalometry

What are the associations between findings from drug-induced sleep endoscopy (DISE) and lateral cephalometry in obstructive sleep apnea (OSA)?

Background: Because surgical treatment of OSA is directed at specific regions and structures of the upper airway, it is important to determine the pattern of obstruction and, if possible, to tailor surgical treatment to a patient’s specific pattern of OSA. Currently, there are two available surgical evaluation techniques: DISE and lateral cephalometric head films.

Study design: Cross-sectional.

Setting: Department of Otolaryngology-Head and Neck Surgery, School of Medicine, and Department of Orthodontics, School of Dentistry, University of California, San Francisco; Prime Orthodontics, Carrollton, Texas.

Synopsis: Fifty-five patients with OSA underwent both DISE (a three-dimensional evaluation of the airway during unconscious sedation, with patients often in a supine position) and lateral cephalometry (a two-dimensional image performed during wakefulness with individuals upright). Despite a wide array of statistical testing, the researchers found few associations between findings of the two evaluation techniques. The two significant associations seen between tongue-related obstruction during DISE and the adjacent anteroposterior airway measurements on lateral cephalogram (airway 5 and airway 6/PAS) were not considered surprising. However, the association between airway 2 and epiglottis-related obstruction on DISE was unexpected, the authors said. There were no associations between the dichotomous characterization of cephalometric measurements and DISE findings, except between tongue-related obstruction and a low airway 5 measurement.

Limitations to the study included its small sample size, the possibility that different combinations of lateral cephalometric head film measures may provide information not available for individual measurements, and the fact that there is presently no gold standard for OSA upper airway evaluation to define the pattern of obstruction.

Bottom line: DISE and lateral cephalometry are largely distinct airway evaluation techniques in OSA, with the use of these techniques remaining complementary.

Reference: George JR, Chung S, Nielsen I, Goldberg AN, Miller A, Kezirian EJ. Comparison of drug-induced sleep endoscopy and lateral cephalometry in obstructive sleep apnea. Laryngoscope. 2012; 122(11):2600-2605.