What are technical considerations for the performance of sleep endoscopy?

Updated: Aug 21, 2019
  • Author: Philip E Zapanta, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

In my practice, I usually perform sleep endoscopy immediately before the proposed OSA surgery. Any planned nasal surgery is usually clear in the clinic, but the sleep endoscopy findings can definitely influence which oropharyngeal and/or hypopharyngeal procedure I perform on the patient. I discuss every possible scenario with my patient, and these visits can easily extend to 30 minutes for counseling purposes.

Another alternative is to perform sleep endoscopy in the operating room and then perform the definitive surgery after the sleep endoscopy discussion in clinic. This is helpful when I do staged, multilevel surgery. I will perform DISE and nasal surgery and then bring the patient back for oropharyngeal/hypopharyngeal OSA surgery. In the interim, I will have discussed the specifics of the DISE with the patient and how I will apply this knowledge in the operating suite.

Consider avoiding muscle relaxant medications such as benzodiazepines, as these can relax the airway too much and possibly give false positives. Croft and Pringle [5] used only midazolam for their DISE, and it was reliable for them. While midazolam does make the patient more at ease in the preoperative area, the propofol dose may be less, compared with a scenario in which the patient does not require midazolam preoperatively.

The safest way to perform sleep endoscopy is with a team approach with your anesthesiologist, with DISE performed in a monitored setting. As described above, communication with your patient and the operative team is important.

In order to get a reliable and valid exam, patience is needed. Allow the propofol infusion to work, and allow the patient to settle down into snoring and then an eventual obstruction.


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