Drug-Induced Sleep Endoscopy as a Selection Tool for Surgical Management of Obstructive Sleep Apnoea Syndrome: Our Personal Experience

Otolaryngologic Side Effects of GLP-1 Receptor Agonists

OBJECTIVES

With the increasing use of GLP-1 receptor agonist (GLP-1 RA) drugs for weight loss and diabetes management, concerns have been raised regarding their potential side effects. We aim to assess the frequency of otolaryngologic adverse events (AEs).

STUDY DESIGN

Retrospective analysis of national registry.

METHODS

The Food and Drug Administration's Adverse Event Reporting System (FAERS) database was queried for events related to the GLP-1 RA: exenatide, liraglutide, dulaglutide, semaglutide, and tirzepatide from 1 year after their approval until the end of 2023. AEs were collected and sub-stratified according to anatomic site. Reporting odds ratios (ROR) and proportional reporting ratios (PRR) were determined for all AEs.

RESULTS

The number of AEs reported from all drugs within this study totaled 9,746. Significant signal ratios were defined as a PRR≥2 and a lower CI ROR >1. Medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) had the highest signals and were significant in virtually all medications. This was followed by GERD which also had very high signal ratios and was significant in all drugs assessed. Semaglutide also had significant signals in anosmia, dry mouth, dysgeusia, and Bell's palsy. Liraglutide had significance in both signals in dysphonia, dysgeusia, tinnitus, and Bell's palsy. This was followed by exenatide which also included dysgeusia and hearing disability.

CONCLUSIONS

GLP-1 RA were associated with various otolaryngologic AEs, with significant signals observed for semaglutide and liraglutide. GERD, MTC, and PTC were of significance in all GLP-1 RA in this study. Monitoring these AEs is recommended.

LEVEL OF EVIDENCE

4 Laryngoscope, 2025.

Effectiveness of drug-induced sleep endoscopy in improving outcomes of barbed pharyngoplasty for obstructive sleep apnea surgery: a prospective randomized trial

PURPOSE

To observe the effectiveness of preoperative drug-induced sleep endoscopy in improving surgical results of patients undergoing single-level barbed pharyngoplasty surgery for OSA, using a prospective randomized model.

METHODS

A single-center randomized controlled trial with two prospective arms was carried out to compare functional results in patients treated with barbed reposition pharyngoplasty (BRP) surgery without a preoperative drug-induced sleep endoscopy (DISE) evaluation vs patients treated with BRP surgery performed after DISE evaluation of sites/patterns of collapse.

RESULTS

We compared 50 patients who underwent BRP without a preoperative DISE evaluation (Group A) and 42 patients (Group B) treated with BRP surgery but preoperatively selected by means of a preoperative DISE. In this second group of patients, after DISE evaluation, 70% of patients were selected for single-level BRP surgery because they showed an isolated velopharyngeal collapse at the DISE evaluation, without obstruction at other upper airway levels evaluated. Both groups of patients showed a statistically significant difference between preoperative and postoperative values of AHI, ODI, and LOS (p<0.05 in all cases). Comparing Group A and Group B patients, the therapeutic success rate was found to be 60% in patients treated without preoperative DISE evaluation and 83% in patients treated with preoperative DISE (p = 0.02).

CONCLUSION

DISE appears to improve the surgical results of single-level velopharyngeal surgery due to the possibility of excluding patients with obstruction of the base of the tongue, the hypopharynx, and the epiglottis/larynx.

Assessment of Site, Degree and Pattern of Airway Obstruction in Patients with Moderate to Severe Obstructive Sleep Apnoea (OSA) Using Drug Induced Sleep Endoscopy (DISE)and Its Association with Awake Fibreoptic Evaluation and Polysomnography Parameters

Accurate assessment of site of obstruction in Obstructive Sleep Apnoea (OSA) is key to its effective management, especially the surgical intervention. Currently, Drug induced sleep endoscopy (DISE) is widely used to assess the obstruction during sleep as assessing during physiologic sleep is impractical and cumbersome. To assess the site, pattern and degree of airway obstruction in patients with moderate to severe obstructive sleep apnoea using DISE and to find a co-relation of DISE findings with awake fibreoptic assessment and severity of OSA. 41 adult patients (29 males, 12 females, mean AHI 40.58 ± 16.94, mean age 54 ± 9.15 years underwent awake fibreoptic nasal endoscopy in the outpatient department and propofol induced DISE in the main operation theatre. The site/s, degree and pattern of obstruction were recorded as per VOTE and Fujita classification. Velum was the commonest site of collapse followed by oropharynx, base of tongue and epiglottis. All had multilevel collapse with velum, oropharynx and base of tongue being the most common combination. At velum, base of tongue and epiglottis, antero-posterior pattern of collapse was commonest and at oropharynx lateral pattern of collapse was the commonest. We found no difference in the site, pattern or severity of collapse between the moderate and severe group though there was a tendency of epiglottis collapse being present more frequently in severe OSA. Awake fibreoptic endoscopic evaluation was able to assess the collapse at level of velum with higher sensitivity but with poor specificity. There was high chances of missing a hypopharyngeal collapse with fibreoptic endoscopic evaluation.

Challenges and perspectives in obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities.

An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.

The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (e.g.nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea–hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.