Abstract
PurposeThe purpose of this international survey is to ascertain the current practice of drug-induced sleep endoscopy (DISE) for patients with sleep-disordered breathing (SDB) by Otolaryngologists in the United Kingdom and Belgium. We compare the results with recommendations from the European Position Paper on drug-induced sleep endoscopy.MethodsAn online questionnaire was circulated to Consultant Otolaryngologists, independent practitioners, and trainees across the two countries. Eleven questions were used in total.Results181 responses from the UK and 117 responses from Belgium were received, mostly from consultants and independent practitioners. SDB was a common presentation to ENT practice, seen by over 90% of clinicians. The use of DISE varied greatly between the two countries (72.9% Belgium, 26.1% UK). 54.1% of Belgian respondents use DISE on over 50% of their patients, compared to only 32.4% of British clinicians. Attitudes of surgeons towards the diagnostic value of DISE varied; in Belgium, the majority (54%) gave a rating of 3 or more (1 = useless to 5 = essential), with no respondents giving a score of 0 (useless). In the UK only 16% of respondents felt DISE had useful clinical value, with 25 respondents deeming it ’useless’. The majority opt for DISE when non-surgical therapies fail (51.4% UK, 61.3% Belgium). The majority of participants do not use objective measures for depth of sedation (75.7% UK, 66.7% Belgium), with a marked variation on anaesthetic methods. 62.2% of UK clinicians do not use a classification system, whereas in Belgium the majority of clinicians (60.8%) use the VOTE grading system.ConclusionsClinicians in Belgium were more favourable to using DISE than in the UK. Differences in its clinical effectiveness were apparent between the two countries. A consensus on patient selection, method of sedation and an effective classification system seemed to be lacking from both countries. Further education is required to raise awareness for the use of DISE.
Highlights
Sleep-disordered breathing (SDB), describes a spectrum of pathologies from ‘simple snoring’ to obstructive sleep apnoea (OSA)
Drug-induced sleep endoscopy (DISE), otherwise known as sleep nasendoscopy, is an investigation that attempts to delineate the level of upper airway obstruction, allowing a targeted treatment for SDB
The Belgium survey had a superior response rate with an email sent to 450 contacts and 117 completing the survey (26.0%)
Summary
Sleep-disordered breathing (SDB), describes a spectrum of pathologies from ‘simple snoring’ to obstructive sleep apnoea (OSA). 12–25% of the remaining users abandon CPAP use in the following 3 years, leading to an estimated overall rate of non-adherence as high as 83% [4]. For this reason, alternative therapies for OSA are often sought. Drug-induced sleep endoscopy (DISE), otherwise known as sleep nasendoscopy, is an investigation that attempts to delineate the level of upper airway obstruction, allowing a targeted treatment for SDB. DISE utilises a light anaesthetic sedation to provide a state similar to natural sleep so that flexible nasendoscopy may be performed and the SDB obstructive level, direction and degree may be identified within the collapsible segment of the individual OSA patient’s upper airway. The use of sleep endoscopy began in 1978 when Borowiecki performed an endoscopic examination of the upper airway (UA) during
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