Abstract
ObjectiveThe aim of this study was to assess the ability of drug-induced sleep endoscopy (DISE) to change therapeutic decisions through the identification of obstruction sites in patients with obstructive sleep apnea (OSA).Materials and methodsA systematic review and meta-analysis were conducted concerning studies that reported the impact of DISE on therapeutic recommendations. The percentage of change was collected for each study and per site of the collapse. The pooled rate of change and the respective 95% confidence interval (CI) were computed. Subgroup analysis was performed based on patients’ age, sample size, the applied DISE protocol, and the originally used diagnostic modality before DISE.ResultsIn a total of nine studies, 1247 patients were included (69.2% males, 59.7% children, 78.04% with a multilevel collapse). Therapeutic decisions changed in 43.69% of patients (CI, 33.84 to 53.54). The change rates were significantly higher in adults (54.0% versus 25.9% in children, P = 0.001), midazolam-based DISE protocols (78.4% versus 48.45% for midazolam plus propofol and 33.9% for propofol, P < 0.001), and after awake endoscopy (62.2% as compared to 44.6% after clinical basic examination [CBE], 40.1% after CBE, lateral cephalometry, and Müller maneuver, P = 0.02). Changes at uvular and palatal sites were more frequent in adults and at the tonsils in children.ConclusionThe DISE approach can be promoted via implementing unified classification systems of obstruction sites; the widescale application of target-controlled infusion and its therapeutic benefits can be explored in well-designed randomized studies that compare its efficacy with other diagnostic modalities.
Highlights
Obstructive sleep apnea (OSA) is a sleep disorder characterized by multiple episodes of partial or complete obstruction of the upper airway, which leads to sympathetic activation, brain arousal, and changes in oxygen saturation in the blood [1]
The change rates were significantly higher in adults (54.0% versus 25.9% in children, P = 0.001), midazolam-based drug-induced sleep endoscopy (DISE) protocols (78.4% versus 48.45% for midazolam plus propofol and 33.9% for propofol, P < 0.001), and after awake endoscopy (62.2% as compared to 44.6% after clinical basic examination [CBE], 40.1% after CBE, lateral cephalometry, and Müller maneuver, P = 0.02)
We showed that DISE-directed decisions were altered in 43.69% of patients
Summary
Obstructive sleep apnea (OSA) is a sleep disorder characterized by multiple episodes of partial or complete obstruction of the upper airway, which leads to sympathetic activation, brain arousal, and changes in oxygen saturation in the blood [1]. The pharynx constitutes the most common sites of obstruction, such as soft palate elongation, swollen uvula, a large tongue, large tonsils, and thickened pharyngeal mucosa. These changes are associated with insomnia, exaggerated day-time sleepiness, and tiredness, yet some patients may be asymptomatic. A confirmed diagnosis is deemed at an AHI ≥ 5, and disease severity depends on the frequency of events. Considering these diagnostic criteria, OSA can be prevalent among 9% to 38% of the general population and it is higher among men, elderly people, and increased body mass index (BMI) [3]. Intuitively, OSA prevalence has substantially increased in concordance with the trend of obesity prevalence over the past 25 years [4]
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