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Viana A, Estevão D, Zhao C. The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea. Ann Med 2022; 54:2909-2920. [PMID: 36269026 PMCID: PMC9590429 DOI: 10.1080/07853890.2022.2134586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: Obstructive sleep apnoea (OSA) is characterized by nocturnal repetitive upper airway (UA) collapse. For sleep physicians, the recognition of UA collapse characteristics is critical for understanding OSA mechanisms and developing individualized treatment plans. Drug-induced sleep endoscopy (DISE) is an exam during simulated sleep that allows the dynamic assessment of the UA of individuals with OSA. The initial recognition of DISE was to locate the sites of UA obstruction and direct the surgical selection of OSA since it was introduced in the 1990s. After approximately 30 years of studies, based on advances in endoscopic operative techniques and innovative treatments of OSA, DISE had been performed to explore mechanisms and comprehensive treatments related to UA collapse. Methods: This article reviewed contemporary DISE advances, including indications and contraindications, technique of induced sleep, endoscopic operation, UA characteristics classification.Results and Conclusions: Precise selection based on the association between collapse patterns and treatment modalities, such as continuous positive airway pressure, oral appliance, positional therapy, robotic surgery and neurostimulator implanting, is the future research prospect based on DISE.Key messagesDISE provides sleep physicians with valuable information about the upper airway collapse characteristics and dynamic changes during sleep.The studies based on DISE findings improve the selectivity and efficiency of treatment modalities, including classical therapies such as continuous positive airway pressure, oral appliance, positional therapy, and innovative therapies such as neurostimulator implanting and robotic surgery, promote the advancement of OSA precision medicine.
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Affiliation(s)
- Alonço Viana
- Graduate Program of Neurology, Rio de Janeiro State Federal University (UNIRIO), Rio de Janeiro, Brazil.,Department of Otorhinolaryngology, Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil
| | - Débora Estevão
- Graduate Program of Neurology, Rio de Janeiro State Federal University (UNIRIO), Rio de Janeiro, Brazil.,Department of Otorhinolaryngology, Glória D'Or Hospital - Rede D'Or São Luiz, Rio de Janeiro, Brazil
| | - Chen Zhao
- Department of Otorhinolaryngology, the First Hospital of China Medical University, Shenyang, China
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Baldassari CM, Lam DJ, Ishman SL, Chernobilsky B, Friedman NR, Giordano T, Lawlor C, Mitchell RB, Nardone H, Ruda J, Zalzal H, Deneal A, Dhepyasuwan N, Rosenfeld RM. Expert Consensus Statement: Pediatric Drug-Induced Sleep Endoscopy. Otolaryngol Head Neck Surg 2021; 165:578-591. [PMID: 33400611 DOI: 10.1177/0194599820985000] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop an expert consensus statement on pediatric drug-induced sleep endoscopy (DISE) that clarifies controversies and offers opportunities for quality improvement. Pediatric DISE was defined as flexible endoscopy to examine the upper airway of a child with obstructive sleep apnea who is sedated and asleep. METHODS Development group members with expertise in pediatric DISE followed established guidelines for developing consensus statements. A search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements regarding DISE in children 0 to 18 years old. Topics with significant practice variation and those that would improve the quality of patient care were prioritized. RESULTS The development group identified 59 candidate consensus statements, based on 50 initial proposed topics, that focused on addressing the following high-yield topics: (1) indications and utility, (2) protocol, (3) optimal sedation, (4) grading and interpretation, (5) complications and safety, and (6) outcomes for DISE-directed surgery. After 2 iterations of the Delphi survey and removal of duplicative statements, 26 statements met the criteria for consensus; 11 statements were designated as no consensus. Several areas, such as the role of DISE at the time of adenotonsillectomy, were identified as needing further research. CONCLUSION Expert consensus was achieved for 26 statements pertaining to indications, protocol, and outcomes for pediatric DISE. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to pediatric DISE.
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Affiliation(s)
- Cristina M Baldassari
- Eastern Virginia Medical School / Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Derek J Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center / University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Norman R Friedman
- Children's Hospital Colorado / University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Terri Giordano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Claire Lawlor
- Children's National Medical Center / George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Heather Nardone
- Nemours / Alfred I. duPont Hospital for Children, New Castle County, Delaware, USA
| | - James Ruda
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Habib Zalzal
- West Virginia University, Morgantown, West Virginia, USA
| | - Adrienne Deneal
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Viana A, Zhao C, Rosa T, Couto A, Neves DD, Araújo-Melo MH, Capasso R. The Effect of Sedating Agents on Drug-Induced Sleep Endoscopy Findings. Laryngoscope 2018; 129:506-513. [PMID: 30194726 DOI: 10.1002/lary.27298] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Drug-induced sleep endoscopy (DISE) has gained interest for upper airway evaluation in patients with snoring and obstructive sleep apnea (OSA), and different drugs have been used to induce sedation. Nevertheless, all drugs have presented specific advantages and disadvantages with differential effects on respiratory physiology. This study evaluated and compared the effects of midazolam, propofol and dexmedetomidine on DISE findings, O2 nadir, and bispectral index (BIS) in the same sample of patients. STUDY DESIGN Case series prospective study. METHODS Consecutive patients who elected to undergo surgery for OSA treatment and were intolerant to conservative therapies underwent DISE with propofol, dexmedetomidine, and midazolam between July 2015 and July 2016. RESULTS Fifty-two patients were analyzed, and 43 (82.7%) were men. Agreement among drugs for both degree and patterns of obstruction was excellent at all sites (velum, oropharynx, and epiglottis) except for the tongue base. Dexmedetomidine had the least complete collapse sites and highest O2 nadir and was the only drug for which apnea severity and obstruction levels (upper, lower, or combined) were correlated. The variability among drug treatments for the BIS index was considerable, and propofol had the lowest variability and average value. CONCLUSION Drug selection had a relevant influence in DISE findings. Compared with dexmedetomidine, midazolam and propofol presented higher incidence of tongue base collapse, lower O2 levels, and lower BIS index values. Propofol resulted in an O2 nadir that most resembled that observed during polysomnography. The BIS index variability differed among drugs, and its use was considered relevant for sedation orientation. LEVEL OF EVIDENCE 4 Laryngoscope, 129:506-513, 2019.
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Affiliation(s)
- Alonço Viana
- Program of Neurology, Rio de Janeiro, Brazil.,Department of Otorhinolaryngology, Marcílio Dias Naval Hospital (HNMD), Rio de Janeiro, Brazil.,Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University, Stanford, California, U.S.A
| | - Chen Zhao
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University, Stanford, California, U.S.A.,Department of Otorhinolaryngology, First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Talita Rosa
- Department of Neurology, University of California, San Francisco, California, U.S.A
| | - Arnaldo Couto
- Department of Pharmacy, West Zone Rio de Janeiro State University (UEZO), Rio de Janeiro, Brazil
| | - Denise Duprat Neves
- Program of Neurology, Rio de Janeiro, Brazil.,Department of Cardiopulmonary, Rio de Janeiro, Brazil
| | - Maria Helena Araújo-Melo
- Program of Neurology, Rio de Janeiro, Brazil.,Department of Otorhinolaryngology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University, Stanford, California, U.S.A
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Lee JS, Heo SJ, Kim JS, Ahn D, Sohn JH, Kim H. Relationship between the severity of laryngopharyngeal reflux and sleep apnea: using drug-induced sleep endoscopy (DISE). Eur Arch Otorhinolaryngol 2017; 275:219-224. [DOI: 10.1007/s00405-017-4812-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/15/2017] [Indexed: 12/21/2022]
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Amos JM, Durr ML, Nardone HC, Baldassari CM, Duggins A, Ishman SL. Systematic Review of Drug-Induced Sleep Endoscopy Scoring Systems. Otolaryngol Head Neck Surg 2017; 158:240-248. [PMID: 29064308 DOI: 10.1177/0194599817737966] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective To systematically review the scoring systems used to report findings during drug-induced sleep endoscopy (DISE) for adults and children with obstructive sleep apnea. Data Sources PubMed, CINAHL, EBM Reviews, Embase, and Scopus databases. Review Methods This is a systematic review of all indexed years of publications referring to scoring of DISE for children and adults with obstructive sleep apnea. The type of DISE scoring system utilized was the primary outcome. PRISMA guidelines were followed to carry out this review; articles were independently reviewed by 2 investigators. All pediatric and adult studies that utilized ≥1 DISE grading systems were included. Results Of 492 identified abstracts, 44 articles (combined population, N = 5784) were ultimately included; 6 reported on children, 35 on adults, and 1 on children and adults. Twenty-one reporting methods were used in these studies, with the most common being the VOTE system (velum, oropharynx, tongue base, and epiglottis; 38.6%) and the Pringle and Croft classification (15.9%). The sites of obstruction most commonly included in a scoring system were the tongue base (62%), lateral pharynx/oropharynx (57%), palate (57%), epiglottis/supraglottis (38%), and hypopharynx (38%). Less commonly included sites were the larynx (29%), velum (23%), nose (23%), tongue (14%), adenoids (10%), and nasopharynx (10%). Conclusion There is no consensus regarding which scoring system should be utilized to report findings during DISE. The VOTE system and the Pringle and Croft classification were the most frequent scoring systems reported for patients undergoing DISE. Standardization of the reporting of DISE findings would improve comparability among studies.
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Affiliation(s)
- Janine M Amos
- 1 Otolaryngology and Facial Plastic Surgery, McLaren Oakland Hospital, Pontiac, Michigan, USA
| | - Megan L Durr
- 2 Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA
| | - Heather C Nardone
- 3 Division of Otolaryngology, Nemours/AI DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Cristina M Baldassari
- 4 Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Angela Duggins
- 5 Division of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,6 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Stacey L Ishman
- 5 Division of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,6 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,7 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Oh MS, Dedhia RC. Current Techniques and Role of Drug-Induced Sleep Endoscopy for Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0082-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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[Drug-induced sedation endoscopy-quo vadis? : Review and outlook]. HNO 2017; 65:125-133. [PMID: 28116457 DOI: 10.1007/s00106-016-0329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Drug-induced sedation endoscopy (DISE) is a diagnostic procedure which allows evaluation of the collapsibility of the upper airway. According to expert opinion, it is possible to imitate nocturnal collapsibility and perform a realistic investigation of the site of obstruction and vibration. This should enable sufficient and precise therapeutic advice to be given solely on the basis of clinical assessment. OBJECTIVE The current publication critically evaluates the present state of development of DISE and its potential indications. MATERIALS AND METHODS A PubMed literature research was performed using "sleep" and "endoscopy" or "DISE" as keywords. Relevant publications were evaluated. RESULTS The present publication provides a historical summary of the available publications and relates these to other methods for examining obstructive sleep apnea. The present state of DISE in terms of drugs applied, grading systems, and validity is evaluated. Indications for DISE are described and critically discussed on the basis of literature data. CONCLUSION DISE provides deep insights into the genesis of obstructions of the upper airway and snoring. Although its value for diagnosis and treatment of sleep-disordered breathing could not yet be demonstrated for all non-CPAP (continuous positive airway pressure) therapies, DISE could identify predictive parameters some methods. Further potential indications for DISE might be predictive examinations for mandibular advancement devices and respiration-synchronous neurostimulation of the hypoglossal nerve. DISE will thus remain a valuable diagnostic tool for obstructive sleep apnea and rhonchopathy.
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Dahl JP, Miller C, Purcell PL, Zopf DA, Johnson K, Horn DL, Chen ML, Chan DK, Parikh SR. Airway Obstruction during Drug-Induced Sleep Endoscopy Correlates with Apnea-Hypopnea Index and Oxygen Nadir in Children. Otolaryngol Head Neck Surg 2016; 155:676-80. [DOI: 10.1177/0194599816653113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/13/2016] [Indexed: 11/17/2022]
Abstract
Objective To determine if standardized intraoperative scoring of anatomic obstruction in children with obstructive sleep apnea correlates with the apnea-hypopnea index (AHI) and lowest oxygen saturation on preprocedural polysomnogram (PSG). A secondary objective was to determine if age, presence of a syndrome, or previous adenotonsillectomy affect this correlation. Study Design Case series with chart review. Setting Two tertiary care children’s hospitals. Subjects Patients with a preprocedural PSG who underwent drug-induced sleep endoscopy (DISE) over a 4-year period. Methods All DISEs were graded in a systematic manner with the Chan-Parikh (C-P) scoring system. AHI and nadir oxygen saturations were extracted from preprocedural PSG. Data were analyzed with a multivariate linear regression model that controlled for age at time of sleep endoscopy, syndrome diagnosis, and previous adenotonsillectomy. Results A total of 127 children underwent PSG prior to DISE: 56 were syndromic, and 21 had a previous adenotonsillectomy. Mean AHI was 13.6 ± 19.6 (± SD), and mean oxygen nadir was 85.4% ± 9.4%. Mean C-P score was 5.9 ± 2.7. DISE score positively correlated with preoperative AHI ( r = 0.36, P < .0001) and negatively correlated with oxygen nadir ( r = −0.26, P = .004). The multivariate linear regression models estimated that for every 1-point increase in C-P score, there is a 2.6-point increase in AHI (95% confidence interval: 1.4-3.8, P < .001) and a 1.1% decrease in the lowest oxygen saturation (95% confidence interval: –1.7 to −0.6, P < .001). Conclusion The C-P scoring system for pediatric DISE correlates with both AHI and lowest oxygen saturation on preprocedural PSG.
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Affiliation(s)
- John P. Dahl
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Craig Miller
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - Patricia L. Purcell
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - David A. Zopf
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
- C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - Kaalan Johnson
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - David L. Horn
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - Maida L. Chen
- Seattle Children’s Hospital, Seattle, Washington, USA
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dylan K. Chan
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
- Benioff Children’s Hospital, San Francisco, California, USA
| | - Sanjay R. Parikh
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children’s Hospital, Seattle, Washington, USA
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Lam DJ, Weaver EM, Macarthur CJ, Milczuk HA, O'Neill E, Smith TL, Nguyen T, Shea SA. Assessment of pediatric obstructive sleep apnea using a drug-induced sleep endoscopy rating scale. Laryngoscope 2016; 126:1492-8. [PMID: 26775080 DOI: 10.1002/lary.25842] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/15/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS Assess the reliability of a Sleep Endoscopy Rating Scale (SERS) and its relationship with pediatric obstructive sleep apnea (OSA) severity. STUDY DESIGN Retrospective case series of pediatric patients who underwent drug-induced sleep endoscopy (DISE) at the time of surgery for OSA from January 1, 2013 to May 1, 2014. METHODS Three blinded otolaryngologists scored obstruction on DISE recordings as absent (0), partial (+1), or complete (+2) at six anatomic levels: nasal airway, nasopharynx, velopharynx, oropharynx, hypopharynx, and arytenoids. Ratings were summed for a SERS total score (range, 0-12). Reliability was calculated using a κ statistic with linear weighting. SERS ratings and obstructive apnea-hypopnea index (OAHI) were compared using Spearman correlation. A receiver operating characteristic (ROC) analysis determined the ability of the SERS total score to predict severe OSA (OAHI >10). RESULTS Thirty-nine patients were included (mean age, 8.3 ± 5.1 years; 36% obese; mean OAHI, 19.1 ± 23.7). Intrarater and inter-rater reliability was substantial-to-excellent (κ = 0.61-0.83) and fair-to-substantial (κ = 0.33-0.76), respectively. Ratings correlated best with OAHI for the oropharynx (r = 0.54, P = .02), hypopharynx (r = 0.48, P = .04), and SERS total score (r = 0.75, P = .002). In ROC analysis, a SERS total score ≥6 demonstrated sensitivity/specificity of 81.8%/87.5%, respectively, and correctly classified 84% of patients. CONCLUSIONS The SERS can be applied reliably in children undergoing DISE for OSA. Ratings of the oropharynx, hypopharynx, and SERS total score demonstrated significant correlation with OSA severity. A SERS total score ≥6 was an accurate predictor of severe OSA. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1492-1498, 2016.
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Affiliation(s)
- Derek J Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Edward M Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Carol J Macarthur
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Henry A Milczuk
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Eleni O'Neill
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Thuan Nguyen
- Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, Oregon
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon, U.S.A
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