Drug Induced Sleep Endoscopy (DISE) is a diagnostic tool used to evaluate CPAP intolerant patients seeking further treatment for their obstructive sleep apnea with Sleep Surgery. Drug induced sleep endoscopy helps to determine the site of obstruction in patients with obstructive sleep apnea. A targeted surgical approach can treat OSA patients.

Drug Induced Sleep Endoscopy

A video of drug induced sleep endoscopy is shown at Sleep Surgery Video. In the video, drug induced sleep endoscopy is shown of a patient who has previously undergone palate surgery as a first stage of treatment. The residual sleep apnea was then diagnosed with drug induced sleep endoscopy with Dr. Jose Barrera, MD and then a mandibular advancement with geniotubercle advancement (lower jaw surgery) was performed to further treat the patient.

San Antonio Plastic Surgeon and ENT Dr. Jose Barrera shows how the site of obstruction in patients with obstructive sleep apnea can be diagnosed with drug induced sleep endoscopy. A targeted approach treating tongue base or hypopharyngeal obstruction by advancing the tongue base can be achieved with mandibular osteotomy with geniotubercle advancement.

CPAP alternative Sleep Surgery Procedures

For patients with obstructive sleep apnea or OSA, obstruction can occur at the level of the soft palate, tongue, or tonsil and pharyngeal walls. Retropalatal obstruction is dealt with a uvulopalatopharyngoplasty or UPPP. UPPP with tonsillectomy involves palate shortening with closure of mucosal incisions, tonsillectomy, and lateral pharyngoplasty.  UPPP results in symptomatic improvement in the patient and eliminates habitual snoring in almost all cases; however, reports show that significant objective improvement on the postoperative polysomnogram ranges only from 41% to 66%. This procedure only eliminates the obstruction at the level of the soft palate, and does not address obstructions occurring in the hypopharyngeal and base of tongue areas. Most patients have more than one site of obstruction. Sleep Endoscopy Sleep Surgery helps to demonstrate each site of airway obstruction under anesthesia. If the site is palatal as shown from sleep endoscopy sleep surgery and if a uvulopalatopharyngoplasty or UPPP is performed then the success rate of the surgical procedure approaches 90% in treating OSA.   Sleep endoscopy sleep surgery also helps to determine tongue base obstruction. Hypopharyngeal or tongue base obstruction is treated with maxillofacial surgery including a genioglossal advancement (GA), or Maxillomandibular Advancement (MMA). GA is a simple technique that does not move the teeth or jaw, and therefore does not affect the dental bite. GA is a procedure performed as a solitary hypopharyngeal procedure or in combination with MMA. The technique places the genioglossus under tension, and this tension may be sufficient to keep the base of tongue region open during sleep. This procedure does not gain more room for the tongue, and thus must be considered a limited procedure that is dependent on the thickness of the individual’s anterior mandible (mean thickness 12–18 mm).   Patients who have had incomplete response or who failed to respond to Phase I intervention may be considered for a Phase II operation or MMA. The advancement of the midface provides more room for the tongue, and sagittal split osteotomy of the mandible places additional tension on the tongue-hyoid complex. Combined advancement of the maxilla and mandible is the most recent and efficacious surgical procedure for the treatment of OSA. The surgical technique includes a standard Le Fort I osteotomy, in combination with a mandibular sagittal split osteotomy. A concomitant GA, as previously described, is recommended to improve tongue advancement. This surgery may result in some facial change, which most often may be favorable.