title: A trial of drug-induced sleep endoscopy in the surgical management of sleep-disordered breathing.
abstract: OBJECTIVE
  To determine the reliability and validity of drug-induced sleep endoscopy (DISE) for patients undergoing surgery for sleep-disordered breathing (SDB).
  
  
  METHODS
  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 (κ 0.61) and interrater (κ 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.
authors.affiliation: Department of Otolaryngology-Head &Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425-5500, USA. gillesmb@musc.edu
authors.forename: M Boyd
authors.initials: MB
authors.lastname: Gillespie
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Reddy
authors.forename: David R
authors.initials: DR
authors.lastname: White
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Discolo
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Overdyk
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous