DISE procedure
The drug-induced sleep endoscopy (DISE) procedure is a diagnostic tool used for studying the airway in a sleeping (sedated) patient with obstructive sleep apnea (OSA).

Drug-induced sleep endoscopy (DISE), also known as sleep nasendoscopy (SNE), is a minimally invasive surgical procedure. It is a diagnostic tool used for studying the airway in a sleeping (sedated) patient with obstructive sleep apnea (OSA).

What is obstructive sleep apnea (OSA)?

Obstructive sleep apnea (OSA) is a sleep disorder that causes the patient’s breathing to stop and start repeatedly during sleep.

The most characteristic feature of OSA is snoring. It happens due to intermittent relaxation of the throat muscles that block the airway while the patient is asleep.

Due to troubled breathing, OSA leads to a gradual fall in oxygen concentration. As a result, the patient gets choking spells that awaken them and disturbs their sleep.

Initial treatment for OSA includes the following devices:

  • A device that uses positive pressure to keep the airway open while the patient is asleep.
  • A mouthpiece to thrust the patient’s lower jaw forward during sleep.

These devices only help in managing the symptoms of OSA. If the patient does not want to use these devices for a lifetime, they can consider corrective surgery for OSA.

What are the advantages of the DISE procedure?

Drug-induced sleep endoscopy (DISE) is a powerful tool for studying the airway in a sleeping patient in real-time. It helps the doctor identify the level and pattern of airway obstruction in a patient with obstructive sleep apnea (OSA). This allows them to tailor the treatment plan for each patient. This can improve the results of the surgery and/or minimize the extent of the planned surgery.

DISE may also provide information that will eliminate the need for surgery for patients with OSA.

How is the DISE procedure performed?

The patient is sedated in a way that is similar to natural sleep. The medication given for sedation is propofol. Sedation allows the surgeons to look inside the throat using a long, thin tube-like camera known as a flexible fiberoptic laryngoscope or an endoscope.

Once the anesthesiologist confirms that the patient is sedated and breathing, the surgeons place the laryngoscope through one of the nostrils and into the throat to examine the airway and nearby possible regions that can cause obstructive sleep apnea (OSA).

Who can undergo the DISE procedure?

Any patient who has documented obstructive sleep apnea (OSA) can be considered for drug-induced sleep endoscopy (DISE) through propofol.

The ideal patient should have

  • Documented OSA.
  • An airway that is considered manageable by the anesthesiologist and surgeon.
  • A patent nasal airway that can allow the easy passage of a fiberoptic laryngoscope.

Who will not be considered for the DISE procedure?

Not all patients with obstructive sleep apnea (OSA) are fit to undergo drug-induced sleep endoscopy (DISE). Following patients are not fit for DISE:

  • Pregnant women
  • Patients with propofol allergy
  • Patients with a significant nasal obstruction that obstructs the passage of a laryngoscope
  • Patients with an airway deemed unsafe by the doctor
  • Patients with a history of aspiration (breathing in a foreign object such as sucking food into the airway)
  • Patients with allergies to propofol components (such as egg lecithin or soybean oil)

What are the risks of the DISE procedure?

Drug-induced sleep endoscopy (DISE) is a relatively safe surgical procedure compared with other surgeries. Possible complications include:

  • Epistaxis (nose bleeding from the injury due to the laryngoscope)
  • Laryngospasm (muscle spasm of the vocal cords), which can cause difficulty in breathing and speaking
  • Aspiration

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Medically Reviewed on 1/13/2021
References
Sleep Endoscopy. Available at: https://emedicine.medscape.com/article/1963060-overview

Sharifian MR, et al. Drug induced sleep endoscopy in obstructive sleep apnea. Tanaffos. 2018;17(2):122-126.