title: Surgical planning after sleep versus awake techniques in patients with obstructive sleep apnea.
abstract: OBJECTIVE
  This study examined correlations between surgical recommendations based on either drug-induced sleep endoscopy (DISE) or common awake examination methods in patients with obstructive sleep apnea syndrome (OSAS).
  
  
  METHODS
  Prospective, blinded, clinical trial at a university hospital.
  
  
  METHODS
  An otorhinolaryngologist designed surgical plans for patients with OSAS after clinical examination, lateral cephalometry, the Müller maneuver, and Friedman staging. A second otorhinolaryngologist blinded to the previous plans made surgical recommendations after DISE. A third person tested agreement between the two sets of plans using Cohen's kappa statistic and the chi-squared test.
  
  
  RESULTS
  One hundred and sixty-two patients (15 females, 147 males) completed the protocol. Good correlation was observed between DISE and Friedman staging regarding recommendations for isolated oropharyngeal or multilevel surgery (kappa = 0.61). Correlations between DISE and clinical examination, lateral cephalometry, and the Müller maneuver regarding surgical procedures on specific structures contributing to upper airway obstruction ranged from fair for velum/tonsil surgery (k = 0.41-0.60) to poor (k = 0.01-0.20) for tongue-base, lateral pharyngeal wall, and epiglottal surgery. The most informative value was DISE versus clinical evaluation, lateral cephalometry, and the Müller maneuver, which changed surgical recommendations concerning the structures contributing to hypopharyngeal or laryngeal obstruction in > 40% of patients.
  
  
  CONCLUSIONS
  Our results indicate that DISE provides more information about the anatomical locations and pattern of obstruction, particularly regarding the specific structures contributing to hypopharyngeal and laryngeal obstruction. DISE changes surgical decision making compared to awake evaluation methods.
authors.affiliation: Otorhinolaryngology Department, University of Valencia, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Fernández-Julián
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: García-Pérez
authors.forename: Javier
authors.initials: J
authors.lastname: García-Callejo
authors.forename: Felipe
authors.initials: F
authors.lastname: Ferrer
authors.forename: Francisco
authors.initials: F
authors.lastname: Martí
authors.forename: Jaime
authors.initials: J
authors.lastname: Marco
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011300:Preoperative Care; D011446:Prospective Studies; D016037:Single-Blind Method; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000601:surgery; D014851:Wakefulness
keywords: Drug-induced sleep endoscopy; Friedman staging system; Müller maneuver; clinical examination; lateral cephalometry; surgical planning