Awake examination versus DISE for surgical decision making in patients with OSA: A systematic review.
OBJECTIVE
Traditionally, upper airway examination is performed while the patient is awake. However, in the past two decades, drug-induced sleep endoscopy (DISE) has been used as a method of tridimensional evaluation of the upper airway during pharmacologically induced sleep. This study aimed to systematically review the evidence regarding the usefulness of DISE compared with that of traditional awake examination for surgical decision making in patients with obstructive sleep apnea (OSA).


METHODS
Scopus, PubMed, and Cochrane Library databases were searched.


METHODS
Only studies with a primary objective of evaluating the usefulness of DISE for surgical decision making in patients with OSA were selected. The included studies directly compared awake examination data with DISE outcome data in terms of possible influences on surgical decision making and operation success.


RESULTS
A total of eight studies with 535 patients were included in this review. Overall, the surgical treatment changed after DISE in 50.24% (standard deviation 8.4) cases. These changes were more frequently associated with structures contributing to hypopharyngeal or laryngeal obstruction. However, these differences do not automatically indicate a higher success rate.


CONCLUSIONS
This review emphasized the direct impact of DISE compared with that of awake examination on surgical decision making in OSA patients. However, it is also clear that the available published studies lack evidence on the association between this impact and surgical outcomes. Laryngoscope, 126:768-774, 2016.
CINTESIS (Center for Research in Health Technologies and Information Systems), University of Porto, Porto, Portugal.|Department of Otorhinolaryngology/Sleep Medicine Center, Hospital CUF and Hospital Sao Sebastiao, Porto, Portugal.
Victor F
VF
Certal
Department of Otorhinolaryngology/Sleep Medicine Center, Hospital CUF and Hospital Sao Sebastiao, Porto, Portugal.
Rui
R
Pratas
Department of Otorhinolaryngology/Sleep Medicine Center, Hospital CUF and Hospital Sao Sebastiao, Porto, Portugal.
Lidia
L
Guimarães
Department of Otorhinolaryngology, Grupo Medico San Pedro, Monterrey, Mexico.
Rodolfo
R
Lugo
Department of Otolaryngology, Division of Sleep Surgery and Medicine, China Medical University Hospital, Taichung, Taiwan.
Yungan
Y
Tsou
Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii.
Macario
M
Camacho
Sleep Surgery Division, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.
Robson
R
Capasso
D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D003657:Decision Making; D004724:Endoscopy / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D017286:Polysomnography / Q000379:methods; D015742:Propofol / Q000008:administration & dosage*; D012890:Sleep / Q000187:drug effects; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000601:surgery*; D014851:Wakefulness
D018686:Anesthetics, Intravenous; D015742:Propofol
DISE; obstructive sleep apnea