Drug-induced Sleep Endoscopy – a Way to Better Results of Surgical Treatment of the Sleep Apnoea Syndrome

Authors: J. Betka;  J. Klozar;  M. Kuchař;  S. Simonidesová;  M. Zábrodský;  J. Plzák
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK a FN v Motole, Praha
Published in: Cesk Slov Neurol N 2016; 79/112(5): 516-520
Category: Review Article


Sleep apnoea syndrome is one of the most common sleep breathing disorders. Despite the wide choice of new approaches available, success rate of surgical treatment is still significantly lower than in case of the positive airway pressure therapy – even though this treatment is not well tolerated by the majority of patients. Drug Induced Sleep Endoscopy is an easy and safe diagnostic method that helps us to identify the exact location, severity and shape of the upper airways obstruction. This facilitates increased precision of subsequent surgery and improves its outcome.

Key words:
sleep apnoea syndrome – drug-induced sleep endoscopy – upper airways obstruction

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


1. Pretl M, Hobzová M, Honnerová M, et al. Indikační kriteria pro léčbu poruch dýchání ve spánku pomocí přetlaku v dýchacích cestách u dospělých. Dokument České společnosti pro výzkum spánku a spánkovou medicínu. [online]. Dostupné z URL: http://www.sleep-society.cz/doporucene-postupy/index.html.

2. Aurora RN, Casey KR, Kristo D, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep 2010; 33 (10): 1408–13.

3. Sullivan CE, Issa FG, Berthon-Jones M, et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1 (8225): 862–5.

4. Stuck BA, Leitzbach S, Maurer JT. Effects of continuous positive airway pressure on apnea-hypopnea index in obstructive sleep apnea based on long-term compliance. Sleep Breath 2012; 16 (2): 467–71. doi: 10.1007/s11325-011-0527-8.

5. Plzak J, Zabrodsky M, Kastner J, et al. Combined bipolar radiofrequency surgery of the tongue base and uvulopalatopharyngoplasty for obstructive sleep apnea. Arch Med Sci 2013; 30: 1097–101.

6. Hessel NS. Snoring and obstructive sleep apnea syndrome: diagnostic and therapeutic aspects: with special emphasis on UPPP. ABC Minimax Grafische Bedrijven B.V. 2004

7. Fernandez-Julian E, Munoz N, Achiques MT, et al. Randomized study comparing two tongue base surgeries for moderate to severe obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 2009; 140 (6): 917–23. doi: 10.1016/j.otohns.2009.02.010.

8. Klozar J, Plzak J, Zabrodsky M, et al. Effectiveness and side effects of one-stage laser-assisted uvuloplasty in primary rhonchopathy. ORL J Otorhinolaryngol Relat Spec 2007; 69 (5): 316–21.

9. Maurer J. Surgical treatment of obstructive sleep apnea: standard and emerging techniques. Curr Opin Pulm Med 2010; 16 (6): 552–8. doi: 10.1097/MCP.0b013e32833ef7ea.

10. Betka J, Klozar J, Kuchař M, et al. Obstrukční syndrom spánkové apnoe – srovnání efektivity různých chirurgických přístupů. Otorinolaryng Foniatr (Pratur) 2014; 63 (1): 3–9.

11. Soares D, Folbe AJ, Yoo G, et al. Drug-induced sleep endoscopy vs awake Müller‘s maneuver in the diagnosis of severe upper airway obstruction. Otolaryngol Head Neck Surg 2013; 148 (1): 151–6. doi: 10.1177/0194599812460505.

12. Woodson BT, Naganuma H. Comparison of methods of airway evaluation in obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 1999; 120 (4): 460–3.

13. Borowiecki B, Pollak CP, Weitzman ED, et al. Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleep-apnea syndrome. Laryngoscope 1978; 88 (1): 1310–3.

14. Pringle MB, Croft CB. A comparison of sleep endoscopy and Mueller manoeuvre. Clin Otolaryngol 1991; 16 (6): 559–62.

15. De Vito A, Carrasco Llatas M, Vanni A, et al. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 2014; 18 (3): 453–65. doi: 10.1007/s11325-014-0989-6.

16. Vanderveken OM. Drug-induced sleep endoscopy (DISE) for non-CPAP treatment selection in patients with sleep-disordered breathing. Sleep Breath 2013; 17 (1): 13–4. doi: 10.1007/s11325-012-0671-9.

17. Kezirian EJ. Non-responders to pharyngeal surgery for obstructive sleep apnea: insights from drug-induced sleep endoscopy. Laryngoscope 2011; 121 (6): 1320–6. doi: 10.1002/lary.21749.

18. Gillespie MB, Reddy RP, White DR, et al. A trial of drug-induced sleep endoscopy in the surgical management of sleep-disordered breathing. Laryngoscope 2013; 123 (1): 277–82. doi: 10.1002/lary.23506.

19. Carrasco Llatas M, Agostini Porras G, Cuesta González MT, et al. Drug-induced sleep endoscopy: a two drug comparison and simultaneous polysomnography. Eur Arch Otorhinolaryngol 2014; 271 (1): 181–7. doi: 10.1007/s00405-013-2548-3.

20. Iwanaga K, Hasegawa K, Shibata N, et al. Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep. Acta Otolaryngol Suppl 2003; 550: 36–40.

21. Berry S, Roblin G, Williams A, et al. Validity of sleep nasenedocopy in the investigation of sleep related breathing disorders. Laryngoscope 2005; 115 (3): 538–40.

22. Kotecha BT, Hannan SA, Khalil HM, et al. Sleep nasendoscopy: a 10-year retrospective audit study. Eur Arch Otorhinolaryngol 2007; 264 (11): 1361–7.

23. Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 2011; 268 (8): 1233–6. doi: 10.1007/s00405-011-1633-8.

24. Vicini C, De Vito A, Benazzo M, et al. The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients. Eur Arch Otorhinolaryngol 2012; 269 (4): 1297–300. doi: 10.1007/s00405-012-1965-z.

25. Gillespie MB, Reddy RP, White DR, et al. A trial of drug-induced sleep endoscopy in the surgical management of sleep-disordered breathing. Laryngoscope 2013; 123 (1): 277–82. doi: 10.1002/lary.23506.

26. Bachar G, Nageris B, Feinmesser R, et al. Novel grading system for quantifying upper-airway obstruction on sleep endoscopy. Lung 2012; 190 (3): 313–8. doi: 10.1007/s00408-011-9367-3.

27. Eichler C, Sommer JU, Stuck BA, et al. Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea? Sleep Breath 2013; 17 (1): 63–8. doi: 10.1007/s11325-012-0647-9.

28. Hessel NS, de Vries N. Results of uvulopalatopharyngoplasty after diagnostic workup with polysomnography and sleep endoscopy: a report of 136 snoring patients. Eur Arch Otorhinolaryngol 2003; 260 (2): 91–5.

29. Bachar G, Feinmesser R, Shpitzer T, et al. Laryngeal and hypopharyngeal obstruction in sleep disordered breathing patients, evaluated by sleep endoscopy. Eur Arch Otorhinolaryngol 2008,265 (11): 1397–402. doi: 10.1007/s00405-008-0637-5.

30. Soares D, Sinawe H, Folbe AJ, et al. Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery. Laryngoscope 2012; 122 (2): 473–9. doi: 10.1002/lary.22474.

31. Arora A, Chaidas K, Garas G, et al. Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment. Sleep Breat 2015; 20 (2): 739–47. doi: 10.1007/s11325-015-1293-9.

32. Vroegop AV, Vanderveken OM, Dieltjens M, et al. Sleep endoscopy with simulation bite for prediction of oral appliance treatment outcome. J Sleep Res 2013; 22 (3): 348–455.

33. Kent DT, Rogers R, Soose RJ. Drug-induced sedation endoscopy in the evaluation of OSA patients with incomplete oral appliance therapy response. Otolaryngol Head Neck Surg 2015; 153 (2): 302–7. doi: 10.1177/0194599815586978.

34. 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): 691–5. doi: 10.1002/lary.22494.

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