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
This is a preview of subscription content, log in to check access.
Dr. Kezirian is currently supported by a career development award from the National Center for Research Resources (NCRR) of the National Institutes of Health and a Triological Society Research Career Development Award of the American Laryngological, Rhinological, and Otological Society. The project was supported by NIH/NCRR/OD UCSF-CTSI Grant Number KL2 RR024130. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Conflict of interest
Croft CB, Pringle M (1991) Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 16:504–509PubMedCrossRefGoogle Scholar
Berry S, Roblin G, Williams A, Watkins A, Whittet HB (2005) Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope 115:538–540PubMedCrossRefGoogle Scholar
Marais J (1998) The value of sedation nasendoscopy: a comparison between snoring and non-snoring patients. Clin Otolaryngol Allied Sci 23:74–76PubMedCrossRefGoogle Scholar
Steinhart H, Kuhn-Lohmann J, Gewalt K, Constantinidis J, Mertzlufft F, Iro H (2000) Upper airway collapsibility in habitual snorers and sleep apneics: evaluation with drug-induced sleep endoscopy. Acta Otolaryngol 120:990–994PubMedCrossRefGoogle Scholar
Rabelo FA, Braga A, Kupper DS et al (2010) Propofol-induced sleep: polysomnographic evaluation of patients with obstructive sleep apnea and controls. Otolaryngol Head Neck Surg 142:218–224PubMedCrossRefGoogle Scholar
Hillman DR, Walsh JH, Maddison KJ et al (2009) Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofol. Anesthesiology 111:63–71PubMedCrossRefGoogle Scholar
Rodriguez-Bruno K, Goldberg AN, McCulloch CE, Kezirian EJ (2009) Test-retest reliability of drug-induced sleep endoscopy. Otolaryngol Head Neck Surg 140:646–651PubMedCrossRefGoogle Scholar
Kezirian EJ, White DP, Malhotra A, Ma W, McCulloch CE, Goldberg AN (2010) Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 136:393–397PubMedCrossRefGoogle Scholar
Iwanaga K, Hasegawa K, Shibata N et al (2003) Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep. Acta Otolaryngol Suppl 550:36–40PubMedCrossRefGoogle Scholar
Hessel NS, Vries N (2004) Increase of the apnoea-hypopnoea index after uvulopalatopharyngoplasty: analysis of failure. Clin Otolaryngol Allied Sci 29:682–685PubMedCrossRefGoogle Scholar
Johal A, Battagel JM, Kotecha BT (2005) Sleep nasendoscopy: a diagnostic tool for predicting treatment success with mandibular advancement splints in obstructive sleep apnoea. Eur J Orthod 27:607–614PubMedCrossRefGoogle Scholar
Johal A, Conaghan C (2004) Maxillary morphology in obstructive sleep apnea: a cephalometric and model study. Angle Orthod 74:648–656PubMedGoogle Scholar
Eckert DJ, Malhotra A, Lo YL, White DP, Jordan AS (2009) The influence of obstructive sleep apnea and gender on genioglossus activity during rapid eye movement sleep. Chest 135:957–964PubMedCrossRefGoogle Scholar
Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR (2005) Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology 103:470–477PubMedCrossRefGoogle Scholar
den Herder C, van Tinteren H, de Vries N (2005) Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring. Laryngoscope 115:735–739CrossRefGoogle Scholar
Hohenhorst W, Stoohs R, Gruenwald S, Koester U, Lamprecht J (2003) Propofol-somnoendoscopy in sleep-disordered breathing. Otolaryngol Head Neck Surg 129:P86CrossRefGoogle Scholar