Drug induced sedated endoscopy (DISE) or sleep endoscopy
Sleep endoscopy was first introduced in the 1990s by Pringle et al. The technique has been slow to gain popularity in the United States, but has been practiced widely in Europe for many years. Sleep endoscopy gives surgeons the ability to directly visualize the site or sites of obstruction that contribute to airway collapse in patients with sleep apnea. Sleep endoscopy complements the overnight polysomnogram (sleep study); the overnight sleep study identifies the severity of sleep apnea, however, it fails to identify the site(s) of obstruction. For the pulmonologist who treats OSA with CPAP or BiPAP it doesn’t really matter where the obstruction occurs because PAP opens the entire airway by acting as a pneumatic splint (some would say a "leaf-blower").
For patients considering surgery, it is critical for the surgeon to know where the site of obstruction is in order to allow the surgeon in removing the correct amount of tissue.. The traditional surgery for OSA (uvulopalatopharyngoplasty –UPPP) developed in the 1980s by Fujita gained a poor reputation because it failed to address the site of obstruction at the back of the tongue. This was in the era before sleep endoscopy. Currently fewer patients undergo UPPP because sleep endoscopy identifies additional obstruction at the base of tongue or epiglottis in one third of patients. This has led to improved results for patients undergoing surgical treatment for OSA.
Sleep endoscopy is performed under twilight anesthesia in an ambulatory surgery center operating room. An anesthetist carefully monitors your breathing while the surgeon examines your airway with a fiber-optic scope very similar to the scope used during your office examination. The scope is first inserted with the patient awake; it is possible to observe the exam during this part of the procedure while the surgeon explains the findings. The patient is then made sleepy using i.v. Propofol. The exam is then repeated with the patient sedated. The findings are recorded for later review and planning for surgery. After the examination the surgeon will discuss the results with the patient and his or her family.
Many patients also complain of nasal obstruction. Nasal obstruction contributes to sleep apnea and also makes it difficult to use CPAP effectively. If indicated, correction of nasal obstruction is performed during sleep endoscopy; this may include septoplasty or radiofrequency of the turbinates.
Sleep endoscopy is a minimally invasive procedure. It involves both an awake portion, which is similar to the office exam, and a sedated portion. The patient is monitored by an anesthetist in an operating room to ensure optimal safety throughout the procedure. Complications could include nose bleed or mild sore throat; these are extremely rare. The need for intubation (breathing tube) is exceedingly rare.