Can drug-induced sleep endoscopy improve the success rates of tongue base surgery?

Abstract

Background: The purpose of this study was to determine the therapeutic value of drug-induced sleep endoscopy (DISE) by comparing the outcomes of tongue base surgery based on Muller's maneuver (MM) and those based on DISE in obstructive sleep apnea (OSA) patients. Methods: Ninety-five patients who underwent the tongue base surgery in combination with palatal surgery for OSA at a tertiary referral hospital between March 2012 and March 2019 were enrolled in this retrospective comparative study. Forty-seven patients underwent MM for surgical decision and 48 patients underwent DISE in addition to MM for surgical decision. Surgical success was defined according to the Sher criteria (postoperative apnea-hypopnea index [AHI] < 20/h and ≥ 50% reduction in preoperative AHI), and AHI improvement (%) was defined as (preoperative AHI-postoperative AHI) × 100/preoperative AHI. For comparison between the MM and DISE groups, p-values were calculated using independent or paired t-tests for continuous variables and using chisquare test for categorical variables. Results: By comparing the results of MM and DISE, consensus on the tongue base level showed insignificant concordance (kappa = 0.017, p = 0.865), whereas that on the oropharynx level showed fair agreement (kappa = 0.241, p = 0.005). AHI, supine AHI, rapid eyeball movement (REM) AHI, non-REM AHI, and nadir oxygen saturation were all significantly improved after the tongue base surgery in both groups. The MM group showed a significant improvement in the Epworth sleepiness scale after the tongue base surgery (p = 0.014), whereas the DISE group did not (p = 0.165). However, there was no significant difference in the AHI improvement (MM group = 47.0 ± 32.0, DISE group = 48.3 ± 35.4, p = 0.852) and surgical success (MM group = 42.6%, DISE group = 45.8%, p = 0.748) between the groups. Tonsil grade (p < 0.05) and occlusion at the oropharynx lateral wall (p = 0.031) were significantly related to surgical success in the MM group. Conclusions: In the judgment of the tongue base surgery, MM and DISE findings showed poor agreement. DISE might affect the surgical decision on the tongue base surgery in OSA patients; however, there was a lack of evidence regarding the superiority of DISE over MM with respect to the surgical outcomes.

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

“…5 Many studies have been published describing patterns of obstruction observed during DISE and associations with baseline OSA severity. 6-9 In addition, there is a growing body of literature describing the impact of DISE on treatment decision making in adult OSA 10-13 and the utility of DISE in predicting surgical outcomes. 14-17…”

“…5 Many studies have been published describing patterns of obstruction observed during DISE and associations with baseline OSA severity. [6][7][8][9] In addition, there is a growing body of literature describing the impact of DISE on treatment decision making in adult OSA [10][11][12][13] and the utility of DISE in predicting surgical outcomes. [14][15][16][17] The widespread utilization of DISE by sleep surgeons and the significant advances that have been made in DISE-related research have led to increased convergence in the practice of adult DISE.…”

One-Stage Multilevel Surgery for Treatment of Obstructive Sleep Apnea Syndrome

“…Recent studies have reported that the surgical plan based on examination of awake patients changed after DISE in 40–50% of patients [ 27 , 28 ]. Improving success rates of sleep surgery [ 29 , 30 ] affects decision making [ 31 ] especially if the tongue was involved; however, there was a lack of evidence regarding the superiority of DISE over Müller’s maneuver with respect to surgical outcomes.…”

Non-acid reflux and sleep apnea: the importance of drug induced sleep endoscopy

“…We have shown that the epiglottis has reduced its swelling and the AHI has improved significantly after 6 months of medical therapy with alginate. There are countless other potential explanations for the differences between the two sleep studies and the two DISE studies [ 22 , 23 ]. However, all of them were exhaustively excluded although retrospectively these factors could be confounding ones: there were no concurrent URTI, the patient does not smoke nor is vaping nor in alcohol use.…”