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European position paper on drug-induced sedation endoscopy (DISE)

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Abstract

Background

Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting.

Methods

The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique.

Results

A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the terminology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied sedation drugs and observation windows. Otherwise, no consensus has been reached on a scoring and classification system.

Conclusions

Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking.

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Acknowledgments

The authors would like to thank the colleagues Dr. Fabio Rabelo, Dr. Eric Thuler, and Dr. Fabiana Valera for attending the consensus meeting and to actively participating in the discussions of the panel and for their strong support in the selection of Figs. 2–7.

Conflict of interest

Andrea De Vito, Marina Carrasco, Agnoletti Vanni, Marcello Bosi, Alberto Braghiroli, Aldo Campanini, Ottavio Piccin, Bhik Kotecha, and Giovanni Sorrenti declare no conflict of interest. Nico de Vries shares in NightBalance, and has otherwise not received any payment or services for this work. de Vries is a member of the Medical Advisory Board of Night Balance, consultant for Philips Healthcare and Olympus, researcher for Inspire Medical Systems, and is a member of the Medical Advisory Board ReVent. Evert Hamans is a consultant for Philips Healthcare. Winfried Hohenhorst is an investigator for Inspire Medical Systems. Joachim Maurer received grant support and personal fees from Inspire; grant support from Imthera, Phillips, and Revent; and personal fees from GlaxoSmithKline, Weinmann, Olympus, ResMed, Neuwirth, Medtronic, and Heinen & Löwenstein. Filippo Montevecchi is a proctor for Intuitive Europe. Olivier Vanderveken received grant support from Inspire Medical Systems and from SomnoMed. Claudio Vicini is a proctor for Intuitive Europe, and is principal investigator for the Sapient Project and an investigator for Imthera iMedNet.

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Correspondence to Olivier M. Vanderveken.

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In the summer of 2013, a group of European experts in the field of sleep endoscopy met in Italy, with the intention of composing a consensus document on drug-induced sedation endoscopy (DISE). The present paper is a reflection of the meeting.

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De Vito, A., Carrasco Llatas, M., Vanni, A. et al. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 18, 453–465 (2014). https://doi.org/10.1007/s11325-014-0989-6

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