Background: Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with obstructive sleep apnea (OSA). To this end, several diagnostic tests and procedures have been developed. These include endoscopic and imaging modalities. However, the latter is not practical as it has issues of logistics and feasibility. The former includes routine awake flexiblescopy (FS) in outpatient department and drug-induced sleep endoscopy (DISE). This study intends to compare the incidence of epiglottic fall, which is the most common laryngeal cause of OSA, in routine awake FS vs DISE. Materials and methods: Thirty patients with OSA were prospectively enrolled in this sectional analytic study. All underwent proper history taking, ENT evaluation including awake FS with Muller's maneuver, polysomnography, and DISE. The upper airway collapse was documented as per velum oropharynx tongue base epiglottis (VOTE) classification. Results: The incidence of epiglottic collapse seen in FS was 6.7% (2 patients) and in DISE was 40% (12 patients), which was statistically significant (p 0.002). Conclusion: Drug-induced sleep endoscopy is a more accurate diagnostic option for detecting the level of obstruction and degree of collapse, especially laryngeal collapse in OSA than FS.
Iber C, Ancoli-Israel S, Chesson AL, et al. The new sleep scoring manual-the evidence behind the rules. J Clin Sleep Med 2007;3(02):107. DOI: 10.5664/jcsm.26812.
Viana Jr AD, Thuler LC, Araújo-Melo MH. Drug-induced sleep endoscopy in the identification of obstruction sites in patients with obstructive sleep apnea: a systematic review. Br J Otorhinolaryngol 2015;81(4):439–446. DOI: 10.1016/j.bjorl.2015.01.007.
Blumen MB, Latournerie V, Bequignon E, et al. Are the obstruction sites visualized on drug-induced sleep endoscopy reliable? Sleep Breath 2015;19(3):1021–1026. DOI: 10.1007/s11325-014- 1107-5.
Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005;28(4):499–521. DOI: 10.1093/sleep/28.4.499.
Aktas O, Erdur O, Cirik AA, et al. The role of drug-induced sleep endoscopy in surgical planning for obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2015;272(8):2039–2043. DOI: 10.1007/s00405-014-3162-8.
Doghramji K, Jabourian ZH, Pilla M, et al. Predictors of outcome for uvulopalatopharyngoplasty. Laryngoscope 1995;105(3 Pt 1):311–314. DOI: 10.1288/00005537-199503000-00016.
Roblin G, Williams AR, Whittet H. Target-controlled infusion in sleep endoscopy. Laryngoscope 2001;111(1):175–176. DOI: 10.1097/00005537-200101000-00031.
De Corso E, Fiorita A, Rizzotto G, et al. The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnoea syndrome: our personal experience. Acta Otorhinolaryngol Ital 2013;33(6):405–413.
De Vito A, Llatas MC, Vanni A, et al. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 2014;18(3):453–465. DOI: 10.1007/s11325-014-0989-6.
Civelek S, Emre IE, Dizdar D, et al. Comparison of conventional continuous positive airway pressure to continuous positive airway pressure titration performed with sleep endoscopy. Laryngoscope 2012;122(3):691–695. DOI: 10.1002/lary.22494.
Lin HC, Friedman M, Chang HW, et al. The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome. Laryngoscope 2008;118(5):902–908. DOI: 10.1097/MLG.0b013e31816422ea.
Hybášková J, Jor O, Novák V, et al. Drug-induced sleep endoscopy changes the treatment concept in patients with obstructive sleep apnoea. Biomed Res Int 2016;2016:6583216. DOI: 10.1155/2016/6583216.
Yegïn Y, Çelik M, Kaya KH, et al. Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system. Br J Otorhinolaryngol 2017;83(4):445–450. DOI: 10.1016/j.bjorl.2016.05.009.
Pilaete K, De Medts J, Delsupehe KG. Drug-induced sleep endoscopy changes snoring management plan very significantly compared to standard clinical evaluation. Eur Arch Otorhinolaryngol 2014;271(5):1311–1319. DOI: 10.1007/s00405-013-2795-3.
Ravesloot MJL, Vries ND. One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope 2011;121(12):2710–2716. DOI: 10.1002/lary. 22369.