Is drug-induced sleep endoscopy associated with better outcomes after soft tissue surgery for sleep apnea? A systematic review and meta-analysis

Abstract

Objectives: The aim was to estimate the effect of drug-induced sleep endoscopy (DISE) on surgical outcomes after soft tissue surgery for obstructive sleep apnea (OSA).

Design and setting: Systematic review and meta-analysis.

Participants: Adult patients with OSA and candidates for soft tissue surgery, with and without preoperative DISE, were included.

Main outcomes measures: A systematic literature search of Medline, Web of Science, and Cochrane databases was performed from inception to December 31, 2021. Studies directly comparing patients with and without preoperative DISE were included. Success rate, change in apnea-hypopnea index (AHI), change in minimum SpO₂ and change in Epworth Sleepiness Scale (ESS) score were extracted. Random-effect models were used to pool estimates.

Results: Seven out of 619 articles were included, representing 791 patients (389 in the DISE group and 402 in the no DISE group). DISE was neither associated with a higher success rate (pooled OR 1.34, 95% CI 0.69-2.59, p = 0.39) after soft tissue surgery for OSA, nor a significant change in AHI (-4.69 events/hour, 95% CI -11.10 to 1.72, p = 0.15), minimal SpO₂ (mean increase of 2.02%, 95% CI -0.26 to 4.29, p = 0.08) and ESS (mean difference of 1.29, 95% CI -0.48 to 3.05, p = 0.15) when compared to patients without preoperative DISE.

Conclusions: Soft tissue surgery does not give better results after DISE compared to when DISE is not performed. However, given the overall low level of evidence of included studies, future well-conducted studies should confirm or overturn these results and clarify the added value of DISE.

Keywords: drug induced sleep endoscopy; meta-analysis; sleep apnea; surgery.