ENT Department, Pitié-Salpétrière Hospital, Sorbonne Université, Paris, France.
Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy.
Sleep Breath. 2024 May;28(2):859-867. doi: 10.1007/s11325-023-02931-z. Epub 2023 Oct 18.
Drug-induced sleep endoscopy (DISE) is the most widespread diagnostic tool for upper-airway endoscopic evaluation of snoring and obstructive sleep apnea (OSA). However, a consensus on the effectiveness of DISE on surgical outcomes is still lacking. This study aimed to quantify the effect of DISE on surgical outcomes and to compare DISE with awake examination using the Müller Maneuver (MM).
This systematic review was performed according to the PRISMA guidelines. Published studies from the last 30 years were retrieved from the Cochrane Library, MEDLINE, SCOPUS, and PubMed databases. Studies comparing DISE with awake examination, or MM were included. Surgical success rate was defined according to Sher's criteria, achieving a postoperative apnoea-hypopnea index (AHI) value < 20 events per hour and a 50% improvement from preoperative AHI. Outcomes are presented in terms of surgical success, pre- and postoperative AHI, Epworth sleepiness score (ESS), oxygen desaturation index (ODI) and lowest oxygen saturation (LOS).
This review included 8 studies comprising 880 patients. DISE group showed a higher LOS increase, ODI decrease, ESS decrease than non-DISE group (6.83 ± 3.7 versus 3.68 ± 2.9, p<0.001; 19.6 ± 11.2 versus 12.6 ± 10.4, p<0.001; 6.72 ± 4.1 versus 3.69 ± 3.1, p<0.001). Differences in surgical success rate were significant only between DISE and MM (64.04% versus 52.48%, p = 0.016). AHI decrease resulted higher in non-DISE than in DISE group (39.92 ± 24.7 versus 30.53 ± 21.7, p<0.001).
Results of this systematic review suggest that the evidence is mixed regarding a positive effect of DISE on surgical outcomes.
药物诱导睡眠内镜检查（DISE）是打鼾和阻塞性睡眠呼吸暂停（OSA）上气道内镜评估最广泛的诊断工具。然而，对于 DISE 对手术结果的有效性仍然缺乏共识。本研究旨在量化 DISE 对手术结果的影响，并使用 Müller 手法（MM）比较 DISE 与清醒检查。
本系统评价按照 PRISMA 指南进行。从 Cochrane 图书馆、MEDLINE、SCOPUS 和 PubMed 数据库中检索了过去 30 年发表的研究。纳入比较 DISE 与清醒检查或 MM 的研究。手术成功率根据 Sher 的标准定义，即术后呼吸暂停低通气指数（AHI）值<20 次/小时，与术前 AHI 相比改善 50%。结果以手术成功率、术前和术后 AHI、Epworth 嗜睡评分（ESS）、氧减指数（ODI）和最低氧饱和度（LOS）表示。
本综述纳入了 8 项研究，共 880 例患者。DISE 组较非 DISE 组 LOS 增加更多，ODI 降低更多，ESS 降低更多（6.83 ± 3.7 与 3.68 ± 2.9，p<0.001；19.6 ± 11.2 与 12.6 ± 10.4，p<0.001；6.72 ± 4.1 与 3.69 ± 3.1，p<0.001）。DISE 与 MM 之间的手术成功率差异仅具有统计学意义（64.04%与 52.48%，p = 0.016）。非 DISE 组 AHI 下降幅度大于 DISE 组（39.92 ± 24.7 与 30.53 ± 21.7，p<0.001）。
本系统评价的结果表明，DISE 对手术结果的影响证据不一。
