Does drug‐induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients

Abstract

Objectives/Hypothesis Our objective was to determine whether drug‐induced sleep apnea (DISE) affects the successfulness of the surgical outcome. Study Design Prospective, seven‐country, nonrandomized trial. Methods There were 326 consecutive obstructive sleep apnea (OSA) patients who had nose, palate, and/or tongue surgery included in the study. DISE was performed in only one group. Results There were 170 patients in the DISE group and 156 patients in no‐DISE group. The mean preoperative body mass index (BMI) for the DISE group was 27.6 ± 4.6, whereas in the no‐DISE group it was 28.1 ± 3.9 (P = .23). The mean preoperative systolic blood pressure (SBP) for the DISE group was 130.4 ± 16.7, whereas in the no‐DISE group it was 142.9 ± 15.5 (P < .001). The mean preoperative diastolic blood pressure (DBP) for the DISE group was 81.4 ± 9.7, whereas in the no‐DISE group it was 89.1 ± 9.7 (P < .001). The mean preoperative apnea‐hypopnea index (AHI) for the DISE group was 32.6 ± 18.8, whereas in the no‐DISE group it was 33.7 ± 19.6 (P = .61). The mean postoperative AHI for the DISE group was 15.9 ± 12.6, whereas in the no‐DISE group it was 13.2 ± 8.8 (P = .023). The age‐, gender‐, BMI‐adjusted percentage change in AHI for the DISE group was −48.4 ± 31.9, whereas in the no‐DISE group it was −59.8 ± 18.6 (P < .001). The age‐, gender‐, and BMI‐adjusted success rate for the DISE group was 66.5%, whereas in the no‐DISE group it was 80.8% (P = .004). The age‐, gender‐, and BMI‐adjusted change in SBP for the DISE group was −6.1 ± 8.6, whereas in the no‐DISE group it was −13.3 ± 11.1 (P < .001). The age‐, gender‐, and BMI‐adjusted change in DBP in the DISE group was −5.2 ± 12.1, whereas in the no‐DISE group it was −12.4 ± 11.7 (P < .001). The mean age‐ and gender‐adjusted change in BMI for the DISE group was −4.6 ± 12.9, whereas in the no‐DISE group it was −6.3 ± 18.5 (P = .34). The Cohen effect of BMI on the overall AHI, lowest oxygen saturation, and blood pressure changes was 0.08. Conclusions DISE may not significantly affect surgical success in OSA. Level of Evidence 2c Laryngoscope, 130:551–555, 2020

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

“…DISE evaluates the specific site and character of the upper airway obstruction during a pharmacological sleep. Although some studies have indicated a higher surgical success rate after DISE 53 , there is insufficient evidence to claim that this approach leads to a better surgical outcome compared to a normal clinical evaluation of the upper airway in fully awake patients 54,55 .…”

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

“…Some studies have reported that DISE-based diagnosis increases the success rates of sleep surgery [24,25]. In a multicenter study on OSA patients with single-or multi-level occlusion, the surgical outcome of DISE was significantly worse than that of MM [26]. However, most of these previous studies compared the surgical outcomes based on MM and DISE, with respect to UPPP (including [2]; AHI < 10/h with ≥50% AHI improvement [3]; ≥50% AHI improvement.…”

Comparison of Findings between Clinical Examinations and Drug-Induced Sleep Endoscopy in Patients with Obstructive Sleep Apnea Syndrome

“…However, selection bias was introduced by collecting more patients with deviated nasal septum in the non-DISE group. The treatment methods differ among tertiary referral centers [ 26 ].…”