3^rd European Otolaryngology-ENT Surgery Conference

Obstructive sleep apnea (OSA) is characterized by intermittent, repeated upper airway narrowing or obstruction occurring during sleep. Most authors agree that rigorous patient selection is logical and mandatory. Successful surgical treatment of OSA is based on the accurate identification of the pattern of airway obstruction and targeted, effective treatment. Nevertheless, surgical results in OSA vary greatly, whatever the surgical technique or site treated. For many years, the primary surgical treatment for obstructive sleep apnea was soft palate surgery, and this worked well for patients with blockage of breathing in the palate region alone. Unfortunately, many patients also appear to have blockage of breathing in the tongue region, and multiple procedures have been developed to address this in the hope of improving surgical outcomes. DISE (Drug induced sleep endoscopy) was introduced almost two decades ago and used extensively since the 2000s. Nevertheless, there are still limited data about the real role of sleep endoscopy in obstructive sleep apnea syndrome. DISE offers a unique structure-based assessment of the airway, compared to other commonly-used evaluation techniques. It mimics sleep in order to observe the upper airway on flexible endoscopy. Because surgical procedures are ultimately directed at specific structures, DISE may improve procedure selection and outcomes. DISE involves a certain number of limitations: natural sleep is not precisely reproduced, the anesthesia protocol is not standardized, and there is no gold-standard validation. Classification is imperfect, indications remain to be standardized. Despite the lack of standardization in clinical examinations, the type of drugs used for sedation and the classification system used, the results obtained till date favor the inclusion of DISE in the investigation of obstruction sites in patients with OSA.