Short Communication

European Archives of Oto-Rhino-Laryngology

, Volume 268, Issue 8, pp 1233-1236

Drug-induced sleep endoscopy: the VOTE classification

  • Eric J. KezirianAffiliated withDepartment of Otolaryngology—Head and Neck Surgery, University of California, San Francisco Email author 
  • , Winfried HohenhorstAffiliated withENT Department, Facial Plastic and Interventional Sleep Medicine
  • , Nico de VriesAffiliated withDepartment of Otolaryngology/Head and Neck Surgery, Sint Lucas Andreas Ziekenhuis

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The surgical evaluation of obstructive sleep apnea is designed to characterize the pattern of upper airway obstruction in order to develop an effective treatment plan for an individual patient. Drug-induced sleep endoscopy (DISE) is one evaluation technique that involves assessment of individuals under pharmacologic sedation designed to simulate natural sleep, utilizing fiberoptic endoscopy to examine the upper airway. Developed in multiple centers throughout Europe, DISE was first described in 1991 and is performed widely around the world. Although multiple studies support a potential role for DISE in evaluation for treatment with surgery and mandibular repositioning appliances, important clinical questions remain unanswered. A major limitation in advancing our understanding of drug-induced sleep endoscopy has been the multiplicity and, in many cases, the complexity of classification systems that prevent the comparison of results across the studies and centers. We present the VOTE classification, a method for characterizing DISE findings that focuses on its core feature, the specific structures that contribute to obstruction.


Sleep apnea Obstructive Surgery Endoscopy Drug-induced sleep endoscopy