Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea

J Clin Sleep Med. 2013 May 15;9(5):433-8. doi: 10.5664/jcsm.2658.


Study objectives: To study the possible predictive value of drug-induced sleep endoscopy (DISE) in assessing therapeutic response to implanted upper airway stimulation (UAS) for obstructive sleep apnea (OSA).

Methods: During DISE, artificial sleep is induced by midazolam and/or propofol, and the pharyngeal collapse patterns are visualized using a flexible fiberoptic nasopharyngoscope. The level (palate, oropharynx, tongue base, hypopharynx/epiglottis), the direction (anteroposterior, concentric, lateral), and the degree of collapse (none, partial, or complete) were scored in a standard fashion.

Results: We report on the correlation between DISE results and therapy response in 21 OSA patients (apnea-hypopnea index [AHI] 38.5 ± 11.8/h; body mass index [BMI] 28 ± 2 kg/m(2), age 55 ± 11 y, 20 male/1 female) who underwent DISE before implantation of a UAS system. Statistical analysis revealed a significantly better outcome with UAS in patients (n = 16) without palatal complete concentric collapse (CCC), reducing AHI from 37.6 ± 11.4/h at baseline to 11.1 ± 12.0/h with UAS (p < 0.001). No statistical difference was noted in AHI or BMI at baseline between the patients with and without palatal CCC. In addition, no predictive value was found for the other DISE collapse patterns documented.

Conclusions: The absence of palatal CCC during DISE may predict therapeutic success with implanted UAS therapy. DISE can be recommended as a patient selection tool for implanted UAS to treat OSA.

Keywords: Electrical stimulation; hypoglossal nerve; neuromodulation; obstructive sleep apnea hypopnea syndrome; prediction; sleep disordered breathing; snoring.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Airway Obstruction / complications
  • Airway Obstruction / diagnosis*
  • Airway Obstruction / therapy
  • Electric Stimulation / methods*
  • Endoscopy / methods*
  • Female
  • Fiber Optic Technology / methods
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Hypoglossal Nerve / surgery*
  • Male
  • Midazolam / administration & dosage
  • Middle Aged
  • Patient Selection*
  • Pharynx / physiopathology
  • Polysomnography / methods
  • Propofol / administration & dosage
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / therapy*
  • Treatment Outcome


  • Hypnotics and Sedatives
  • Midazolam
  • Propofol