Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases

Laryngoscope. 2014 Mar;124(3):797-802. doi: 10.1002/lary.24479. Epub 2013 Dec 11.


Objectives/hypothesis: To describe upper airway (UA) collapse patterns during drug-induced sleep endoscopy (DISE) in a large cohort of patients with sleep-disordered breathing (SDB) and to assess associations with anthropometric and polysomnographic parameters.

Study design: Observational study.

Methods: A total of 1,249 patients [age 47 ± 10 y; apnea-hypopnea index (AHI) 18.9 ± 15.3/h; body mass index (BMI) 27.2 ± 3.7 kg/m(2)] underwent polysomnography and DISE. DISE findings were categorized to the following UA levels: palate, oropharynx, tongue base, and hypopharynx. The degree of collapse was reported as complete, partial, or none. The pattern of the obstruction was described as anteroposterior, lateral, or concentric. Associations between DISE findings and anthropometric and polysomnographic parameters were analyzed.

Results: Palatal collapse was seen most frequently (81%). Multilevel collapse was noted in 68.2% of all patients. The most frequently observed multilevel collapse pattern was a combination of palatal and tongue base collapse (25.5%). Palatal collapse was seen most frequently (81%). The prevalence of complete collapse, multilevel collapse, and hypopharyngeal collapse increased with increasing severity of obstructive sleep apnea (OSA). Multilevel and complete collapse were more prevalent in obese patients and in those with more severe OSA. Both higher BMI and AHI values were associated with a higher probability of complete concentric palatal collapse.

Conclusion: The current study provides an overview of UA collapse patterns in a large cohort of SDB patients who underwent DISE. The associations found in this study may indicate that UA collapse patterns observed during DISE cannot be fully explained by selected baseline polysomnographic and anthropometric characteristics.

Keywords: Drug-induced sleep endoscopy; obstructive sleep apnea; polysomnography; sleep-disordered breathing.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Airway Obstruction / etiology
  • Airway Obstruction / physiopathology*
  • Anthropometry
  • Body Mass Index
  • Clinical Competence
  • Cohort Studies
  • Endoscopy / adverse effects
  • Endoscopy / methods*
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Infusions, Intravenous
  • Logistic Models
  • Male
  • Midazolam / administration & dosage
  • Middle Aged
  • Odds Ratio
  • Oropharynx / drug effects
  • Oropharynx / physiopathology
  • Palate / drug effects
  • Palate / physiopathology
  • Polysomnography / methods
  • Propofol / administration & dosage
  • Risk Assessment
  • Sex Factors
  • Sleep / drug effects
  • Sleep Apnea Syndromes / diagnosis*
  • Sleep Apnea Syndromes / therapy
  • Statistics, Nonparametric


  • Hypnotics and Sedatives
  • Midazolam
  • Propofol