A trial of drug-induced sleep endoscopy in the surgical management of sleep-disordered breathing

作者：Gillespie M Boyd^*; Reddy Ryan P; White David R; Discolo Christopher M; Overdyk Frank J; Nguyen Shaun A

来源：Laryngoscope, 2013, 123(1): 277-282.

DOI：10.1002/lary.23506

• Drug-induced sleep endoscopy
• DISE
• sleep endoscopy
• sleep nasendoscopy
• obstructive sleep apnea
• sleep-disordered breathing
• Level of Evidence: 4

Objectives/Hypothesis: To determine the reliability and validity of drug-induced sleep endoscopy (DISE) for patients undergoing surgery for sleep-disordered breathing (SDB). Study Design: Non-randomized, prospective clinical trial. Methods: Patients with sleep-disordered breathing were evaluated for multi-level upper airway surgery by awake and drug-induced sleep endoscopy to identify levels and degree of airway collapse. The reliability of a drug-induced sleep endoscopy rating index was assessed by comparing scores of three blinded investigators. The validity was assessed by comparison of drug-induced sleep endoscopy index scores from awake and drug-induced sleep endoscopy; correlation between drug-induced sleep endoscopy scores and Apnea-Hypopnea Index; and determination whether drug-induced sleep endoscopy affected the original surgical plan. Results: Thirty-eight patients (22 M, 16 F) underwent preoperative assessment with awake and drug-induced sleep endoscopy. Drug-induced sleep endoscopy was successfully performed in all but one patient (97%) who became combative during propofol infusion. Using an internal airway grading scale, drug-induced sleep endoscopy demonstrated more severity of collapse than awake endoscopy (P = 0.0001). The surgical plan was changed after drug-induced sleep endoscopy in 23 (62%) cases and unchanged in 14 (38%). The majority (73%) had multi-segmental airway collapse with fewer having single-level palatal (16%) or tongue base (11%) collapse. Scoring of drug-induced sleep endoscopy videos demonstrated good intrarater (? 0.61) and interrater (? 0.65) correlation. Conclusions: Drug-induced sleep endoscopy provides more clinical information to assess airway function and collapse than awake endoscopy alone and assists in the surgical planning. Additional investigation is needed to standardize drug-induced sleep endoscopy techniques, training, and interpretation. Laryngoscope, 2013

• 出版日期2013-1