De Vito Andrea, Carrasco Llatas Marina, Ravesloot Madeline J, Kotecha Bhik, De Vries Nico, Hamans Evert, Maurer Joachim, Bosi Marcello, Blumen Marc, Heiser Clemens, Herzog Michael, Montevecchi Filippo, Corso Ruggero Massimo, Braghiroli Alberto, Gobbi Riccardo, Vroegop Anneclaire, Vonk Patty Elisabeth, Hohenhorst Winfried, Piccin Ottavio, Sorrenti Giovanni, Vanderveken Olivier M, Vicini Claudio
Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.
ENT Unit, Santa Maria delle Croci Hospital, Ravenna AUSL of Romagna, Romagna, Italy.
Clin Otolaryngol. 2018 Dec;43(6):1541-1552. doi: 10.1111/coa.13213. Epub 2018 Sep 30.
The first edition of the European position paper (EPP) on drug-induced sleep endoscopy (DISE) was published in 2014 with the aim to standardise the procedure, to provide an in-depth insight into the main aspects of this technique and to have a basis for future research. Since 2014, new studies have been published concerning new sedative agents or new insights into the pattern/levels of the obstruction depending on the depth of sedation. Therefore, an enlarged group of European experts in the field of sleep breathing disorders (SBD), including the most of the first DISE EPP main authors, has decided to publish an update of the European position paper on DISE, in order to include new evidence and to find a common language useful for reporting the findings of this endoscopic evaluation in adult population affected by SBD.
The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centres in order to provide an update regarding the standardisation of the DISE procedure and an in-depth insight into the main aspects of this technique.
After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued.
欧洲药物诱导睡眠内镜检查（DISE）立场文件第一版于2014年发布，旨在规范该检查程序，深入洞察该技术的主要方面，并为未来研究奠定基础。自2014年以来，已发表了有关新型镇静剂或根据镇静深度对阻塞模式/程度的新见解的新研究。因此，包括大多数第一版DISE立场文件主要作者在内的欧洲睡眠呼吸障碍（SBD）领域的专家扩大组决定发布DISE欧洲立场文件的更新版，以纳入新证据，并找到一种通用语言，用于报告在受SBD影响的成年人群中进行这种内镜评估的结果。
作者评估了文献中报道的所有现有证据，并比较了欧洲主要中心各科室的经验，以便提供有关DISE程序标准化的更新内容，并深入了解该技术的主要方面。
在第一次欧洲DISE立场共识会议及其更新之后，在适应症、所需的初步检查、DISE的实施地点、所需的技术设备、人员配备、局部麻醉、鼻充血、其他药物、患者体位、基本和特殊诊断操作、药物及观察窗口方面达成了共识。到目前为止，在评分和分类系统上尚未达成共识。然而，关于这一目标，一种基本分类的想法，如VOTE，并有可能逐步实施其信息和描述分级，似乎是现阶段就DISE分类达成普遍共识的最佳方式。一种通用的DISE语言是必不可少的，应该努力达成一个被普遍接受的系统。
