title: Drug-Induced Sedation Endoscopy in the Evaluation of OSA Patients with Incomplete Oral Appliance Therapy Response.
abstract: OBJECTIVE
  To use drug-induced sedation endoscopy (DISE) to identify locations and patterns of residual collapse in patients with obstructive sleep apnea (OSA) with incomplete response to oral appliance therapy (OAT).
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic multidisciplinary sleep practice.
  
  
  METHODS
  Thirty-five consecutively screened adult patients with OSA with continuous positive airway pressure (CPAP) intolerance and incomplete response to OAT (apnea-hypopnea index [AHI] >15 or AHI >5 with persistent subjective symptoms) who underwent DISE with and without the oral appliance. Data collected included demographics, body mass index, polysomnography data, and management decisions after DISE. Each DISE video pair was retrospectively scored using the VOTE classification system by the same blinded reviewer (R.J.S.).
  
  
  RESULTS
  All patients had multilevel airway collapse at baseline. The palate was the most common location of OAT failure. Fifteen (42.9%) had persistent collapse of the velum during DISE with OAT, and 7 (20%) had persistent collapse of the epiglottis. Twenty-three (65.7%) patients were offered targeted surgery based on DISE findings to augment OAT effectiveness. Twenty (57.1%) patients underwent additional medical therapy such as OAT adjustment or cervical positional therapy. Mean AHI was reduced from 37.4 at baseline, to 16.4 with OAT (P < .01), and to 10.7 after post-DISE intervention (P < .78).
  
  
  CONCLUSIONS
  In patients with incomplete response to OAT, DISE with and without the appliance can identify residual anatomical locations of collapse, which may direct additional medical and surgical treatment options to augment OAT effectiveness. Further work is needed to determine if DISE affects outcomes.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Kent
authors.affiliation: Pittsburgh Dental Sleep Medicine, PC, Pittsburgh, Pennsylvania, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Rogers
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA sooserj@upmc.edu.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Soose
mesh_terms: D045422:Continuous Positive Airway Pressure; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010159:Palate / Q000503:physiopathology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy
keywords: continuous positive airway pressure; drug-induced sedation endoscopy; obstructive sleep apnea; oral appliance