Anesthesia and Drug Induced Sleep Endoscopy (DISE)

Abstract

Drug-induced sleep endoscopy (DISE) is a diagnostic procedure used to evaluate the upper airway in patients with obstructive sleep apnea (OSA) by mimicking natural sleep conditions. OSA is a disorder characterized by repetitive collapse of the upper airway during sleep. Standard treatment for OSA is continuous positive airway pressure therapy (CPAP). However, up to 50% of patients with OSA are unable to tolerate CPAP obligating alternative treatments. DISE allows for the direct visualization of airway dynamics, which aids in identifying the site and pattern of obstruction, thereby guiding treatment decisions. It has been the most used technique to identify specifc areas of obstruction and patterns of airway collapse that serves as a baseline screening tool for both surgical and non-surgical options.1 A variety of drugs are available for sedating patients undergoing DISE, with the goal of achieving a level of sedation that closely mimics natural sleep. The most often utilized agents are propofol, midazolam, and dexmedetomidine.2 While no absolute contraindications exist unique to DISE, relative contraindications include drug allergy to selected sedative agents, pregnancy, and medical comorbidities resulting in signifcant airway compromise. Anesthesia plays a crucial role in DISE, as it must induce a sleep-like state without compromising airway patency or patient safety.