title: Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea?
abstract: OBJECTIVE
  Success rates of non-ventilation therapies for sleep disordered breathing (SDB) remain hardly acceptable. Drug-induced sleep endoscopy (DISE) tends to show the level and mechanism of obstruction and helps to specify therapy individually. Therefore, increasing success rates are expected. The objective of this study is to detect whether locations of treatment recommendations given after DISE are different to those made after clinical basic ENT (ear, nose, throat) examination (CBE).
  
  
  METHODS
  This study included patients with obstructive sleep apnea (OSA) and primary snoring who wish or require an alternative therapy to the gold standard, continuous positive airway pressure (CPAP). After CBE, a theoretical treatment recommendation was given comprising surgery (possible surgical target: soft palate, tonsils, tongue base, epiglottis) and mandibular advancement splints (MAS) or both. A second ENT specialist conducted a DISE and independently recommended a second therapy concept without knowing the first one. A third person compared both theoretical locations of treatment recommendations (CBE vs. DISE).
  
  
  RESULTS
  A total of 97 patients (eight female and 89 male, age 30-85 years, AHI 1.9-88.6/h, body mass index [BMI] 20.3-36.3 kg/m²) received two therapy recommendations. Regarding surgical options only, 63.9% of the examined patients got a different recommendation in at least one of four levels. If MAS was included, a change was found in 78.4% of the patients. Subdivided into each type of intervention, the following changes were found in the therapy concept: 24.7% (n = 24/97) soft palate, 12.4% (n = 12/97) tonsils, 33.0% (n = 32/97) tongue base, 27.8% (n = 27/97) epiglottis, 38.1% (n = 37/97) MAS.
  
  
  CONCLUSIONS
  DISE shows a relevant influence on the location of treatment recommendation. Thus, a change in success rates of non-CPAP therapy in OSA and snoring appears possible.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Mannheim, Germany. corlette.eichler@umm.de
authors.forename: Corlette
authors.initials: C
authors.lastname: Eichler
authors.forename: J Ulrich
authors.initials: JU
authors.lastname: Sommer
authors.forename: Boris A
authors.initials: BA
authors.lastname: Stuck
authors.forename: Karl
authors.initials: K
authors.lastname: Hörmann
authors.forename: Joachim T
authors.initials: JT
authors.lastname: Maurer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous; D004724:Endoscopy; D004825:Epiglottis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement; D008874:Midazolam; D008875:Middle Aged; D017090:Occlusal Splints; D010160:Palate, Soft / Q000601:surgery; D017286:Polysomnography; D011379:Prognosis; D012890:Sleep / Q000187:drug effects*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000601:surgery*; D012913:Snoring / Q000175:diagnosis / Q000628:therapy; D014059:Tongue / Q000601:surgery; D014068:Tonsillectomy
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam