uDISE model: a universal drug-induced sedation endoscopy classification system—part 1

Abstract

Drug-induced sedation endoscopy (DISE) classification systems play a significant role in clinical analysis based on DISE findings, treatment decision process, treatment planning process and fundamentally in treatment outcomes. However, there is a major problem: there is no universally agreed DISE classification system. Hence, for the same DISE examination different DISE classification systems can be used to: assess anatomic findings, decide and plan different treatments. Hence, this leads to different treatment outcomes. The key objective of this study is to propose uDISE model: universal drug-induced sedation endoscopy (DISE) classification system. Set theory and relational mapping was used to develop a DISE classification system based on anatomical structures/level; degree of severity; and configuration of obstruction and its relationship with existing DISE classification systems. uDISE model consists of seven anatomical sites (nose, velum, tonsils, lateral pharyngeal wall/oropharynx, tongue base, epiglottis and larynx), three degrees of obstructive severity (none, partial and complete), three configurations of obstruction (anteroposterior, lateral and circumferential) and a severity index. uDISE model was mapped to four existing DISE classification systems: Pringle and Croft grading system, VOTE, NOHL and P-T-L-Tb-E. uDISE model provides a methodology for mapping different DISE findings based on different classification systems into one common DISE assessments format. This provides a framework for comparing different DISE assessments, treatment plan and treatment outcome irrespective of DISE classification system used. Further research is required to establish a complete relational mapping between uDISE model and other existing DISE classification systems.

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

“…3 DISE has since then increased its popularity and employed worldwide. However, controversies related to the indications, required technical equipment, 4 drug type [5][6][7] and dose, 8 the best classification to describe findings, 9 and significant interrater variability of DISE have been raised. 10 Different drugs have been used to induce sedation during DISE, including midazolam, 3 propofol 11 and dexmedetomidine.…”

Is epiglottis surgery necessary for obstructive sleep apnea patients with epiglottis obstruction?

“…The type of obstruction was reported as complete or partial. The dynamic patterns of closure were reported using the velum, oropharynx, tongue base, epiglottis classification system (anteroposterior, concentric, and lateral) . The scoring sheet was completed a second time by the principal investigator based on DISE assessment.…”

“…Drug‐induced sleep endoscopy (DISE) is considered to be an essential tool in the evaluation of upper airway collapsibility patterns in patients with obstructive sleep apnea (OSA) . Since it was first described in 1991, many studies have evaluated its role in surgical planning before multilevel sleep surgery .…”

The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea

“…The discussion and comparison between these two systems mainly focussed on the classification of obstructive sites; VOTE was thought to have more comprehensive analysis on the epiglottis and pharynx than NOHL [ 38 ]. Later, the universal Drug-Induced Sedation Endoscopy (u-DISE) classification was created to combine the results obtained in the above classifications [ 39 ]. It consists of seven sites (nose, soft palate, tonsils, lateral pharyngeal/oropharyngeal wall, tongue base, epiglottis and larynx), compared with four sites of VOTE and NOHL.…”