Drug-Induced Sleep Endoscopy
DISE
Overview
Sleep endoscopy, also known as drug-induced sleep endoscopy (DISE), is a medical procedure used to evaluate and diagnose the causes of obstructive sleep apnea (OSA) and other sleep-related breathing disorders. This diagnostic technique involves using endoscopy, a thin, flexible tube with a camera and light at its tip, to examine the upper airway while the patient is in a sleep-like state induced by sedation or anesthesia.
DISE is often used in conjunction with other diagnostic tests, such as polysomnography, to provide a more comprehensive assessment of a patient's sleep disorder. It can be particularly valuable when determining whether surgical interventions are appropriate.
Procedure & Examination
During a DISE procedure, the patient is given sedative medications or placed under light anesthesia to simulate natural sleep conditions. This is essential to replicate the relaxed state of the upper airway, which often collapses or obstructs during sleep in individuals with OSA.
While the patient is in the sleep-like state, an ear, nose, and throat (ENT) specialist or a sleep medicine physician inserts the endoscope through the nose or mouth and advances it to view the upper airway structures. This allows direct visualization of the throat, palate, tonsils, uvula, tongue base, and other relevant anatomical features.
The real-time endoscopic images enable the healthcare provider to identify specific areas of obstruction or anatomical abnormalities contributing to sleep-related breathing problems. This information helps in tailoring treatment recommendations for the individual patient.
Once the source of obstruction is identified, treatment options can be discussed. These may include lifestyle modifications, positional therapy, weight loss, oral appliances, or surgical interventions, depending on the severity and nature of the obstruction.
Preparations & Post-procedure
Before undergoing Drug-Induced Sleep Endoscopy (DISE), there are several preparations that should be taken into account to ensure a safe and effective procedure.
Consultation. During the consultation with your healthcare provider, typically an ear, nose, and throat (ENT) specialist or a sleep medicine physician, discuss your medical history, symptoms, and any previous sleep studies or evaluations. At this point, it is also imperative to inform your healthcare provider about all medications you are currently taking, including prescription, over-the-counter, and herbal supplements. Some medications may need to be adjusted or temporarily stopped before the procedure, especially if they can interact with the sedative drugs used during DISE.
Fasting. You will likely be instructed to fast for a specific period before the procedure, typically for several hours. This fasting is necessary to reduce the risk of complications, such as aspiration of stomach contents during sedation.
Transportation. Arrange for someone to accompany you to the procedure and drive you home afterward. The sedative or anesthesia used during DISE can impair your ability to drive safely for a certain period, so it's important not to drive yourself.
After the procedure, the following may be expected:
Recovery. After the DISE procedure, you will be monitored by healthcare professionals until you are fully awake and alert. This may take some time, as the sedative or anesthesia effects wear off.
Discharge Instructions. Your healthcare provider will provide specific post-procedure instructions. Follow these guidelines carefully, which may include dietary restrictions, limitations on physical activity, and driving restrictions.
Residual Effects. Be aware that you may experience some lingering effects from the sedative or anesthesia, such as drowsiness, grogginess, or mild memory lapses. These effects should resolve within a day or two.
Keep contact information for your healthcare provider readily available in case you experience any unexpected or concerning symptoms after the procedure.
