title: European position paper on drug-induced sedation endoscopy (DISE).
abstract: BACKGROUND
  Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting.
  
  
  METHODS
  The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique.
  
  
  RESULTS
  A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the terminology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied sedation drugs and observation windows. Otherwise, no consensus has been reached on a scoring and classification system.
  
  
  CONCLUSIONS
  Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking.
authors.affiliation: Special Surgery Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Via Forlanini 34, 47121, Forlì, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Vito
authors.forename: Marina
authors.initials: M
authors.lastname: Carrasco Llatas
authors.forename: Agnoletti
authors.initials: A
authors.lastname: Vanni
authors.forename: Marcello
authors.initials: M
authors.lastname: Bosi
authors.forename: Alberto
authors.initials: A
authors.lastname: Braghiroli
authors.forename: Aldo
authors.initials: A
authors.lastname: Campanini
authors.forename: Nico
authors.initials: N
authors.lastname: de Vries
authors.forename: Evert
authors.initials: E
authors.lastname: Hamans
authors.forename: Winfried
authors.initials: W
authors.lastname: Hohenhorst
authors.forename: Bhik T
authors.initials: BT
authors.lastname: Kotecha
authors.forename: Joachim
authors.initials: J
authors.lastname: Maurer
authors.forename: Filippo
authors.initials: F
authors.lastname: Montevecchi
authors.forename: Ottavio
authors.initials: O
authors.lastname: Piccin
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sorrenti
authors.forename: Olivier M
authors.initials: OM
authors.lastname: Vanderveken
authors.forename: Claudio
authors.initials: C
authors.lastname: Vicini
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016292:Procedural Sedation; D004359:Drug Therapy, Combination; D004724:Endoscopy; D005060:Europe; D019317:Evidence-Based Medicine; D006801:Humans; D008874:Midazolam; D010038:Otorhinolaryngologic Diseases / Q000175:diagnosis*; D015742:Propofol; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000628:therapy
chemical_list: D008874:Midazolam; D015742:Propofol