Procedure
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 a 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.
Examination
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.
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Candidates for DISE
Drug-induced sleep endoscopy (DISE) is a generally safe procedure, but there are some people who should not undergo it. These include:
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People with an allergy to propofol or other sedatives used in the procedure
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People with severe respiratory problems, such as asthma or chronic obstructive pulmonary disease (COPD)
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People with severe heart disease
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People with uncontrolled high blood pressure
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People who are pregnant or breastfeeding
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People who are currently taking certain medications, such as blood thinners or antiplatelet drugs
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In addition to the above, DISE may not be recommended for people with the following conditions:
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Severe obesity
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Severe facial deformities
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Recent head or neck surgery
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Active infection
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If you have any of these conditions, talk to your doctor about the risks and benefits of DISE before making a decision.
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It is also important to note that DISE is not always necessary. If your doctor is able to diagnose obstructive sleep apnea (OSA) based on your medical history, physical exam, and other tests, they may not recommend DISE. However, DISE can be helpful in determining the best course of treatment for OSA, especially if you are considering surgery. Read more about OSA here.
Preparations
Before undergoing 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.
Post-procedure
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.
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Keep contact information for your healthcare provider readily available in case you experience any unexpected or concerning symptoms after the procedure.