The Influence of Drug-Induced Sleep Endoscopy on Determining Candidacy for Upper Airway Stimulation Therapy

Abstract

Objectives:

(1) Determine the influence of drug-induced sleep endoscopy (DISE) on the surgical decision for upper airway stimulation (UAS) therapy. (2) Learn the limitations of drug induced sleep endoscopy.

Methods:

This was a single-blinded cross-sectional study in which 4 surgeons with extensive experience with DISE reviewed blinded DISE video clips from 63 patients who were screened for participation in the STAR (Stimulation Therapy for Apnea Reduction) trial, a phase III trial of upper airway stimulation (UAS) of the hypoglossal nerve for moderate-to-severe sleep apnea (OSA). Each DISE clip was independently reviewed and graded by a surgeon who then predicted whether the patient was a candidate for UAS therapy.

Results:

Evaluators demonstrated a high level of 100% agreement with regard to the presence of palatal collapse in 81% of cases, but less complete agreement concerning hypopharyngeal collapse (64% of cases). The viewers had complete agreement with regards to the presence or absence of circumferential airway collapse in 59% of cases. The surgeons had a low level of complete agreement (44% of cases; mean kappa 0.343) as to whether a given case was a good candidate for UAS therapy.

Conclusions:

DISE continues to be a highly subjective study. Previous evidence found that patients with circumferential airway collapse on DISE respond poorly to UAS. Additional training will be necessary in the future in order to increase agreement among surgeons as to which patients are the best candidates for UAS therapy.