Awake examination versus DISE for surgical decision making in patients with OSA: A systematic review

Abstract

Objective: Traditionally, upper airway examination is performed while the patient is awake. However, in the past two decades, drug-induced sleep endoscopy (DISE) has been used as a method of tridimensional evaluation of the upper airway during pharmacologically induced sleep. This study aimed to systematically review the evidence regarding the usefulness of DISE compared with that of traditional awake examination for surgical decision making in patients with obstructive sleep apnea (OSA).Data Sources: Scopus, PubMed, and Cochrane Library databases were searched. Review Methods: Only studies with a primary objective of evaluating the usefulness of DISE for surgical decision making in patients with OSA were selected. The included studies directly compared awake examination data with DISE outcome data in terms of possible influences on surgical decision making and operation success.Results: A total of eight studies with 535 patients were included in this review. Overall, the surgical treatment changed after DISE in 50.24% (standard deviation 8.4) cases. These changes were more frequently associated with structures contributing to hypopharyngeal or laryngeal obstruction. However, these differences do not automatically indicate a higher success rate.Conclusion: This review emphasized the direct impact of DISE compared with that of awake examination on surgical decision making in OSA patients. However, it is also clear that the available published studies lack evidence on the association between this impact and surgical outcomes.

The Effect of Sedating Agents on Drug‐Induced Sleep Endoscopy Findings

“…Surgical planning performed according to the findings of an awake examination can change after DISE, and these differences do not automatically indicate a higher success rate. 35 DISE performed with midazolam changed surgical recommendations concerning structures contributing to hypopharyngeal or laryngeal obstruction in 62% of patients, 36 whereas with propofol the result was approximately 40%, 37 and in the case of midazolam combined with propofol the result was 62%. 38 Our study has confirmed that drug selection can affect the choice of proper surgical technique(s), leading to possible excessive or insufficient treatment.…”

Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea?

“…In this study, we focused only on the retrobasilingual space because other obstruction sites in the upper airway, such as the velum, oropharynx, palatine tonsils, and lingual tonsils, were well investigated. Moreover, the hypopharynx seems to be the most important obstruction site in OSAHS . In a computed tomography (CT)‐based study, Vos et al reported a significant correlation between the severity of OSAHS and the shape of the airway flow behind the epiglottis .…”

“…Moreover, the hypopharynx seems to be the most important obstruction site in OSAHS. 4,11,12 In a computed tomography (CT)-based study, Vos et al reported a significant correlation between the severity of OSAHS and the shape of the airway flow behind the epiglottis. 13 In another CT-based study, 14 an elongated shape for airway flow was associated with OSAHS, especially when the anteroposterior retroglossal dimension was reduced.…”

Efficacy of Upper Gastrointestinal Endoscopic Examination to Identify Patients with Obstructive Sleep Apnea Syndrome: A Retrospective Cross-Sectional Study

“…Trans-nasal endoscopy may be more useful since the nasopharynx or upper part of the oropharynx can be evaluated. When interpreting the results of awake trans-nasal endoscopy, it is worth remembering that lower pharyngeal obstruction is more common while the subject is asleep than awake, and DISE plays a significant role in laryngeal obstruction in OSAS patients [29,30].…”