Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients

Kenny P Pang; Peter M Baptista; Ewa Olszewska; Itzhak Braverman; Marina Carrasco-Llatas; Srivinas Kishore; Sudipta Chandra; Hyung Chae Yang; Cybil Mei Zhi Wang; Yiong Huak Chan; Kathleen A Pang; Edward B Pang; Brian Rotenberg

doi:10.1002/lary.27987

Does drug-induced sleep endoscopy affect surgical outcome? A multicenter study of 326 obstructive sleep apnea patients

Laryngoscope. 2020 Feb;130(2):551-555. doi: 10.1002/lary.27987. Epub 2019 Apr 17.

Authors

Affiliations

¹ Otolaryngology Department, Asia Sleep Centre, Paragon, Singapore.
² Otolaryngology Department, Clinica Universidad de Navarra, Pamplona, Spain.
³ Ear, Nose, and Throat Department, Medical University of Bialystok, Bialystok, Poland.
⁴ Department of Otolaryngology-Head and Neck Surgery, Hillel Yaffe Medical Center, Technion Faculty Medicine, Haifa, Israel.
⁵ Ear, Nose, and Throat Department, Hospital Universitario Dr. Peset, Valencia, Spain.
⁶ Otolaryngology Department, Nova Specialty Hospital, Hyderabad, India.
⁷ Ear, Nose, and Throat Department, Belle Vue Clinic and Hospital, Kolkata, India.
⁸ Otolaryngology Department, Chonnam National University Hospital, Gwangju, South Korea.
⁹ Biostatistics Unit, School of Medicine, National University Singapore, Singapore.
¹⁰ Medicine Faculty, University of Glasgow, Glasgow, United Kingdom.
¹¹ Otolaryngology Department, Western University, London, Ontario, Canada.

PMID: 30993741
DOI: 10.1002/lary.27987

Abstract

Objectives/hypothesis: Our objective was to determine whether drug-induced sleep apnea (DISE) affects the successfulness of the surgical outcome.

Study design: Prospective, seven-country, nonrandomized trial.

Methods: There were 326 consecutive obstructive sleep apnea (OSA) patients who had nose, palate, and/or tongue surgery included in the study. DISE was performed in only one group.

Results: There were 170 patients in the DISE group and 156 patients in no-DISE group. The mean preoperative body mass index (BMI) for the DISE group was 27.6 ± 4.6, whereas in the no-DISE group it was 28.1 ± 3.9 (P = .23). The mean preoperative systolic blood pressure (SBP) for the DISE group was 130.4 ± 16.7, whereas in the no-DISE group it was 142.9 ± 15.5 (P < .001). The mean preoperative diastolic blood pressure (DBP) for the DISE group was 81.4 ± 9.7, whereas in the no-DISE group it was 89.1 ± 9.7 (P < .001). The mean preoperative apnea-hypopnea index (AHI) for the DISE group was 32.6 ± 18.8, whereas in the no-DISE group it was 33.7 ± 19.6 (P = .61). The mean postoperative AHI for the DISE group was 15.9 ± 12.6, whereas in the no-DISE group it was 13.2 ± 8.8 (P = .023). The age-, gender-, BMI-adjusted percentage change in AHI for the DISE group was -48.4 ± 31.9, whereas in the no-DISE group it was -59.8 ± 18.6 (P < .001). The age-, gender-, and BMI-adjusted success rate for the DISE group was 66.5%, whereas in the no-DISE group it was 80.8% (P = .004). The age-, gender-, and BMI-adjusted change in SBP for the DISE group was -6.1 ± 8.6, whereas in the no-DISE group it was -13.3 ± 11.1 (P < .001). The age-, gender-, and BMI-adjusted change in DBP in the DISE group was -5.2 ± 12.1, whereas in the no-DISE group it was -12.4 ± 11.7 (P < .001). The mean age- and gender-adjusted change in BMI for the DISE group was -4.6 ± 12.9, whereas in the no-DISE group it was -6.3 ± 18.5 (P = .34). The Cohen effect of BMI on the overall AHI, lowest oxygen saturation, and blood pressure changes was 0.08.

Conclusions: DISE may not significantly affect surgical success in OSA.

Level of evidence: 2c Laryngoscope, 130:551-555, 2020.

Keywords: Drug-induced sleep endoscopy; obstructive sleep apnea; success rate.

Publication types

Clinical Trial
Multicenter Study

MeSH terms

Endoscopy / methods*
Female
Humans
Hypnotics and Sedatives / pharmacology*
Male
Middle Aged
Prospective Studies
Sleep / drug effects*
Sleep Apnea, Obstructive / surgery*

Substances

Hypnotics and Sedatives