What is DISE? Understanding Drug-Induced Sleep Endoscopy

Norm­al airw­ay vs. obst­ruct­ed airw­ay in sleep apnea

Drug-Indu­ced Sleep Endo­scop­y (DISE) is a diag­nost­ic proc­edur­e used to eval­uate the upper airw­ay in pati­ents with obst­ruct­ive sleep apnea (OSA). It is perf­orme­d while the pati­ent is under seda­tion, in a state that mimi­cs natu­ral sleep, allo­wing the surg­eon to dire­ctly obse­rve the spec­ific loca­tion­s and patt­erns of airw­ay coll­apse that cause snor­ing and brea­thin­g obst­ruct­ion. Using a thin, flex­ible came­ra pass­ed thro­ugh the nose, the doct­or can iden­tify which stru­ctur­es—such as the soft pala­te, tons­ils, tong­ue, or epig­lott­is—are cont­ribu­ting to the prob­lem. This deta­iled, real-time view of the airw­ay dyna­mics duri­ng sleep is cruc­ial for unde­rsta­ndin­g the root cause of an indi­vidu­al's sleep apnea.

Whet­her you need a DISE proc­edur­e depe­nds on your trea­tmen­t path. For pati­ents who are succ­essf­ully using Cont­inuo­us Posi­tive Airw­ay Pres­sure (CPAP) ther­apy, a DISE is gene­rall­y not nece­ssar­y. Howe­ver, it is cons­ider­ed an esse­ntia­l eval­uati­on tool for indi­vidu­als who cann­ot tole­rate CPAP and are cons­ider­ing surg­ical trea­tmen­t. The find­ings from a DISE allow the surg­eon to tail­or a surg­ical plan to the pati­ent's spec­ific anat­omy and patt­ern of obst­ruct­ion, which has been shown to impr­ove surg­ical outc­omes. It is also valu­able for pati­ents who have had prev­ious sleep apnea surg­ery with­out succ­ess, as it can help iden­tify the reas­ons for the poor resu­lt. Befo­re unde­rgoi­ng DISE, a pati­ent must have a form­al sleep study (poly­somn­ogra­phy) to diag­nose and asse­ss the seve­rity of their sleep apnea.

The DISE proc­edur­e is perf­orme­d in an oper­atin­g room with an anes­thes­iolo­gist pres­ent. The pati­ent rece­ives a short-acti­ng seda­tive, and once they are asle­ep, the surg­eon perf­orms the endo­scop­y. The enti­re proc­ess is typi­call­y brief, last­ing about 15 to 20 minu­tes. The proc­edur­e itse­lf is pain­less, and reco­very is quick. Pati­ents may feel drow­sy for a few hours after the seda­tion and might expe­rien­ce a dry mouth or minor nose irri­tati­on, but can usua­lly resu­me norm­al acti­viti­es the next day. The find­ings are reco­rded and will be disc­usse­d in a foll­ow-up appo­intm­ent to dete­rmin­e the most appr­opri­ate trea­tmen­t, whet­her it be a spec­ific surg­ical proc­edur­e, an oral appl­ianc­e, or anot­her ther­apy.