OSA Treatment: Drug-Induced Sleep Endoscopy May Not Significantly Affect Surgical Success

Does drug-induced sleep endoscopy (DISE) affect the success of nose, palate, or tongue surgery for obstructive sleep apnea (OSA) patients?

Bottom line: Contrary to an instinctive belief that DISE improves results, DISE may not significantly affect surgical success in OSA.

BACKGROUND: Due to the dynamic balance of forces within the upper airway, the awake airway and sleep airway are completely different. Upper airway evaluation is crucial to anatomical obstruction site assessment, as many OSA patients have bulky, thick lateral pharyngeal walls that contribute to upper airway collapse and obstruction. DISE has been suggested to identify the obstruction, but it can be labor intensive and expensive.

STUDY DESIGN: Prospective, seven-country, nonrandomized trial of 326 (170 DISE, 156 no-DISE) OSA patients who had nose, palate, and/or tongue surgery.

SETTING: Nine tertiary clinical centers from seven countries, including Singapore, Canada, India, Spain, Poland, Israel, and Korea. 

SYNOPSIS: There were 42 mild (19 DISE, 23 no-DISE), 116 moderate (77 DISE, 39 no-DISE), and 155 severe (70 DISE, 85 no-DISE) OSA patients. Statistically significant results included decreases in systolic blood pressure for the moderate (DISE 7.01% ± 8.0%, no-DISE 13.3% ± 8.2%) and severe (DISE 5.7% ± 8.6%, no-DISE 13.1% ± 11.8%) groups; in diastolic blood pressure for the moderate (DISE 7.8% ± 12.5%, no-DISE 12.5% ± 11.3%) and severe (DISE 3.7% ± 10.6%, no-DISE 12.1% ± 10.6%) groups; in the Epworth Sleepiness Scale for the severe group (DISE 50.9% ± 30.7%, no-DISE 60.8% ± 22.9%); in the snoring visual analog scale for the mild (DISE 39.7% ± 54.3%, no-DISE 66.4% ± 16.0%) and severe (DISE 46.5% ± 51.6%, no-DISE 69.7% ± 20.7%) groups; and in the apnea-hypopnea index for the mild (DISE 32.0% ± 58.5%, no-DISE 59.5% ± 15.0%) and severe (DISE 50.2% ± 27.7%, no-DISE 61.7% ± 17.4%) groups. A total of 625 surgical procedures were done in the DISE group (148 nose, 59 tongue) compared to 632 procedures done in the no-DISE group (113 nose, 24 tongue). Limitations included a lack of uniformity in choice and technique of DISE procedures.

CITATION: Pang KP, Baptista PM, Olszewska E, et al. Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients. Laryngoscope. 2020;130:551-555.