drug induced sleep endoscopy; meta-analysis; sleep apnea; surgery; Otorhinolaryngology
Abstract :
[en] [en] OBJECTIVES: The aim was to estimate the effect of drug-induced sleep endoscopy (DISE) on surgical outcomes after soft tissue surgery for obstructive sleep apnea (OSA).
DESIGN AND SETTING: Systematic review and meta-analysis.
PARTICIPANTS: Adult patients with OSA and candidates for soft tissue surgery, with and without preoperative DISE, were included.
MAIN OUTCOMES MEASURES: A systematic literature search of Medline, Web of Science, and Cochrane databases was performed from inception to December 31, 2021. Studies directly comparing patients with and without preoperative DISE were included. Success rate, change in apnea-hypopnea index (AHI), change in minimum SpO2 and change in Epworth Sleepiness Scale (ESS) score were extracted. Random-effect models were used to pool estimates.
RESULTS: Seven out of 619 articles were included, representing 791 patients (389 in the DISE group and 402 in the no DISE group). DISE was neither associated with a higher success rate (pooled OR 1.34, 95% CI 0.69-2.59, p = 0.39) after soft tissue surgery for OSA, nor a significant change in AHI (-4.69 events/hour, 95% CI -11.10 to 1.72, p = 0.15), minimal SpO2 (mean increase of 2.02%, 95% CI -0.26 to 4.29, p = 0.08) and ESS (mean difference of 1.29, 95% CI -0.48 to 3.05, p = 0.15) when compared to patients without preoperative DISE.
CONCLUSIONS: Soft tissue surgery does not give better results after DISE compared to when DISE is not performed. However, given the overall low level of evidence of included studies, future well-conducted studies should confirm or overturn these results and clarify the added value of DISE.
Disciplines :
Otolaryngology
Author, co-author :
Lisan, Quentin ; Department of Head and Neck surgery, Foch Hospital, Suresnes, France
Baudouin, Robin ; Department of Head and Neck surgery, Foch Hospital, Suresnes, France
Lechien, Jérome ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Education > Service de Métrologie et Sciences du langage
Hans, Stéphane; Department of Head and Neck surgery, Foch Hospital, Suresnes, France
Blumen, Marc; Department of Head and Neck surgery, Foch Hospital, Suresnes, France
Language :
English
Title :
Is drug-induced sleep endoscopy associated with better outcomes after soft tissue surgery for sleep apnea? A systematic review and meta-analysis.
Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310–8. https://doi.org/10.1016/S2213-2600(15)00043-0
Kent D, Stanley J, Aurora RN, Levine CG, Gottlieb DJ, Spann MD, et al. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17:2507–31. https://doi.org/10.5664/jcsm.9594
Zaghi S, Holty JEC, Certal V, Abdullatif J, Guilleminault C, Powell NB, et al. Maxillomandibular advancement for treatment of obstructive sleep apnea: a meta-analysis. JAMA Otolaryngol Neck Surg. 2016;142(1):58. https://doi.org/10.1001/jamaoto.2015.2678
Aurora RN, Casey KR, Kristo D, Auerbach S, Bista SR, Chowdhuri S, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep. 2010;33(10):1408–13. https://doi.org/10.1093/sleep/33.10.1408
Croft CB, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol. 1991;16(5):504–9. https://doi.org/10.1111/j.1365-2273.1991.tb01050.x
Zerpa Zerpa V, Carrasco Llatas M, Agostini Porras G, Dalmau Galofre J. Drug-induced sedation endoscopy versus clinical exploration for the diagnosis of severe upper airway obstruction in OSAHS patients. Sleep Breath. 2015;19(4):1367–72. https://doi.org/10.1007/s11325-015-1266-z
Eichler C, Sommer JU, Stuck BA, Hörmann K, Maurer JT. Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea? Sleep Breath. 2013;17(1):63–8. https://doi.org/10.1007/s11325-012-0647-9
Certal VF, Pratas R, Guimarães L, Lugo R, Tsou Y, Camacho M, et al. Awake examination versus DISE for surgical decision making in patients with OSA: a systematic review: the importance of DISE for surgical decision making. Laryngoscope. 2016;126(3):768–74. https://doi.org/10.1002/lary.25722
Stanley JJ. Drug-induced sleep endoscopy: techniques, interpretation and implications. Curr Opin Pulm Med. 2020;26(6):623–8. https://doi.org/10.1097/MCP.0000000000000723
Pang KP, Baptista PM, Olszewska E, Braverman I, Carrasco-Llatas M, Kishore S, et al. Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients. Laryngoscope. 2020;130(2):551–5. https://doi.org/10.1002/lary.27987
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https://doi.org/10.1136/bmj.l4898
Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919
Chapter 6: Choosing effect measures and computing estimates of effect | Cochrane Training. Accessed February 7, 2022. https://training.cochrane.org/handbook/current/chapter-06#section-6-5-2-8
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. https://doi.org/10.1002/sim.1186
Chen RF, Nakayama M, Sung WC, Hung JF, Chu YM. Comparison of surgical outcomes of sleep surgeries preoperatively evaluated with drug-induced sleep endoscopy and Müller's maneuver. Auris Nasus Larynx. 2021;49:235–9. https://doi.org/10.1016/j.anl.2021.08.001
Golbin D, Musgrave B, Succar E, Yaremchuk K. Clinical analysis of drug-induced sleep endoscopy for the OSA patient: DISE for the OSA patient. Laryngoscope. 2016;126(1):249–53. https://doi.org/10.1002/lary.25516
Ha JG, Lee Y, Nam JS, Park JJ, Yoon JH, Kim CH, et al. Can drug-induced sleep endoscopy improve the success rates of tongue base surgery? J Otolaryngol – Head Neck Surg. 2020;49(1):8. https://doi.org/10.1186/s40463-020-00405-w
Huntley C, Chou D, Doghramji K, Boon M. Preoperative drug induced sleep endoscopy improves the surgical approach to treatment of obstructive sleep apnea. Ann Otol Rhinol Laryngol. 2017;126(6):478–82. https://doi.org/10.1177/0003489417703408
Pang KP, Piccin O, Pang EB, Pang KA, Chan YH, Rotenberg BW. Combined expansion pharyngoplasty and anterior palatoplasty for the treatment of OSA. Indian J Otolaryngol Head Neck Surg. 2016;68(4):528–33. https://doi.org/10.1007/s12070-016-1020-2
Iannella G, Magliulo G, Cammaroto G, Meccariello G, de Vito A, Pelucchi S, et al. Effectiveness of drug-induced sleep endoscopy in improving outcomes of barbed pharyngoplasty for obstructive sleep apnea surgery: a prospective randomized trial. Sleep Breath. 2021;26:1621–32. https://doi.org/10.1007/s11325-021-02528-4
Kezirian EJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol. 2011;268(8):1233–6. https://doi.org/10.1007/s00405-011-1633-8
Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep. 1996;19(2):156–77. https://doi.org/10.1093/sleep/19.2.156
MacKay S, Carney AS, Catcheside PG, Chai-Coetzer CL, Chia M, Cistulli PA, et al. Effect of multilevel upper airway surgery vs medical management on the apnea-hypopnea index and patient-reported daytime sleepiness among patients with moderate or severe obstructive sleep apnea: the SAMS randomized clinical trial. JAMA. 2020;324(12):1168–79. https://doi.org/10.1001/jama.2020.14265
Altintaş A, Yegin Y, Çelik M, Kaya KH, Koç AK, Kayhan FT. Interobserver consistency of drug-induced sleep endoscopy in diagnosing obstructive sleep apnea using a VOTE classification system. J Craniofac Surg. 2018;29(2):e140–3. https://doi.org/10.1097/SCS.0000000000003876
Kezirian EJ, White DP, Malhotra A, Ma W, McCulloch CE, Goldberg AN. Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Neck Surg. 2010;136(4):393–7. https://doi.org/10.1001/archoto.2010.26
Green KK, Kent DT, D'Agostino MA, Hoff PT, Lin HS, Soose RJ, et al. Drug-induced sleep endoscopy and surgical outcomes: a multicenter cohort study. Laryngoscope. 2019;129(3):761–70. https://doi.org/10.1002/lary.27655
Vroegop AVMT, Vanderveken OM, Wouters K, Hamans E, Dieltjens M, Michels NR, et al. Observer variation in drug-induced sleep endoscopy: experienced versus nonexperienced ear, nose, and throat surgeons. Sleep. 2013;36(6):947–53. https://doi.org/10.5665/sleep.2732
Soares D, Sinawe H, Folbe AJ, Yoo G, Badr S, Rowley JA, et al. Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery. Laryngoscope. 2012;122(2):473–9. https://doi.org/10.1002/lary.22474
Wang Y, Sun C, Cui X, Guo Y, Wang Q, Liang H. The role of drug-induced sleep endoscopy: predicting and guiding upper airway surgery for adult OSA patients. Sleep Breath. 2018;22(4):925–31. https://doi.org/10.1007/s11325-018-1730-7
Strollo PJ, Soose RJ, Maurer JT, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139–49. https://doi.org/10.1056/NEJMoa1308659
de Vito A, Carrasco Llatas M, Ravesloot MJ, et al. European position paper on drug-induced sleep endoscopy: 2017 update. Clin Otolaryngol. 2018;43(6):1541–52. https://doi.org/10.1111/coa.13213
MacKay SG, Lewis R, McEvoy D, Joosten S, Holt NR. Surgical management of obstructive sleep apnoea: a position statement of the Australasian Sleep Association. Respirology. 2020;25(12):1292–308. https://doi.org/10.1111/resp.13967
Trzepizur W, Blanchard M, Ganem T, et al. Sleep apnea–specific hypoxic burden, symptom subtypes, and risk of cardiovascular events and all-cause mortality. Am J Respir Crit Care Med. 2022;205(1):108–17. https://doi.org/10.1164/rccm.202105-1274OC
Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Neck Surg. 2002;127(1):13–21. https://doi.org/10.1067/mhn.2002.126477