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Drug-induced Sleep Endoscopy Tailors Treatment to Patient

Drug-Induced Sleep Endoscopy in Obstructive Sleep Apnea

On-Demand Session

 

Drug-induced sleep endoscopy (DISE) allows for the fiberoptic examination of a sedated obstructive sleep apnea (OSA) patient—and if the sedation is done right, respiratory patterns will be as close as possible to what they would be during natural sleep.

It’s a procedure that varies in prevalence depending on which part of the world you practice in—with different insurance coverages, drug costs, and other considerations—but the advantages, said panelists, are considerable.

Eric J. Kezirian, MD, MPH, of Keck School of Medicine of USC in Los Angeles, California; Nico de Vries, MD, PhD, of OVLG West Hospital and  Academisch Centrum Tandheelkunde Amsterdam in the Netherlands and the University of Antwerp in Belgium; and Winfried Hohenhorst, MD, PhD of Alfreid Krupp Hospital in Essen, Germany, said that specific benefits of DISE include:

  • The ability to directly visualize the location of obstruction and involved structures.
  • The ability to differentiate vibration versus obstruction.
  • Moderate to good reliability.
  • The ability to perform a unique evaluation.
  • The ability to identify involved structures more precisely and potentially direct surgical treatment.
  • The ability to detect epiglottis, which is not possible with other evaluations.

The panelists discussed what they have dubbed a VOTE classification, which is a structure-based assessment that aids physicians in making individualized treatment decisions. VOTE classification, while containing a wide range of complexity, can be used to describe the following patterns of collapse:

  • Nose/nasopharynx
  • Velum (palate, uvula, lateral velopharyngeal walls)
  • Oropharyngeal later walls, tonsils
  • Tongue base
  • Epiglottis
  • Larynx

The configuration of obstruction in each structure may be classified as antero-posterior, lateral, or concentric.

While potential DISE disadvantage are not to be discounted—including the length of time it takes to perform, the cost, and the sedatives involved—Dr. Kezirian said , “Really treating people more specifically in a tailored way could be very helpful.” Ultimately DISE may enable targeted, more effective, and less invasive treatment of snoring and OSA.

This Expert Lecture was presented live on Tuesday, September 15, 10:00 – 11:00 am (ET) but is now available in the on-demand library of education content.

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