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Drug-Induced Sleep Endoscopy (DISE)
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Introduction
Drug-induced sleep endoscopy (DISE) was introduced by Croft and Pringle in 1991 and over time has increased in popularity and is applied worldwide. The evaluation requires pharmacologic induction of sedation and flexible fiber-optic endoscopy to visualize upper airway obstruction and/or snoring. As opposed to most surgical evaluation techniques, DISE not only uniquely offers a dynamic evaluation of the upper airway during conditions that ideally mimic natural sleep, but also enables visualization of specific structures that contribute to upper airway obstruction.
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Indications
Home sleep apnea testing or polysomnography (PSG) must be performed before DISE. Assessment of the site(s) of obstruction is paramount to surgical success, and possibly by applying a jaw thrust during DISE, one may predict the likelihood that a mandibular advancement device (MAD) would be effective. Hence DISE is employed as a diagnostic tool for patients with habitual snoring, as well as those with obstructive sleep apnea (OSA) when surgery or MAD therapy is being considered as a treatment option by the patient and physician. Furthermore DISE can be applied to improve understanding of the anatomic basis for surgical, MAD, or continuous positive airway pressure (CPAP) failure and to evaluate additional conservative medical or surgical treatment alternatives. DISE is not necessary if CPAP, weight loss, or positional therapy is being considered, as visualization of the level of obstruction is not mandatory for these treatment modalities.
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Contraindications
A high American Society of Anesthesiologists score and propofol or midazolam allergies (albeit rare) are considered contraindications. As a result of the negative influence on treatment success, severe OSA and severe obesity are relative contraindications.
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