Awake versus drug-induced sleep endoscopy: evaluation of airway obstruction in obstructive sleep apnea/hypopnoea syndrome

Abstract

Objectives/hypothesis: To compare the degree and patterns of upper airway obstruction, as detected by endoscopy with Müller's maneuver versus drug-induced sleep endoscopy (DISE).

Methods: Sixty-six patients (60 males and 6 females), with a mean age of 49.59 ± 13.04 years, underwent videonasal-pharyngo-laryngoscopy to asses anatomy and dynamic behavior of upper airways during the Müller's maneuver awake, and during DISE by Propofol with boluses refracted technique.

Results: In the majority of our patients, we detected an obstruction due to nasal septal deviation (91%) and turbinate hypertrophy (100%). The pattern of the obstruction caused by the soft palate and the tongue base was similar in DISE and Müller's maneuver, whereas the registered degree was significantly higher in DISE. Concerning the larynx, 22.7% of patients showed an involvement of the epiglottis during sedation that was not assessable during wakefulness.

Conclusions: DISE is a simple additional tool to plan surgical treatment in patients with OSAHS, and in our hands has proven to be more accurate and precise than endoscopy with Müller's maneuver.