SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

DRUG-INDUCED SLEEP ENDOSCOPY

Mehmet Fatih Çakmak

Ordu University Training and Research Hospital, Department of Otorhinolaryngology, Ordu, Türkiye

Çakmak MF. Drug-Induced Sleep Endoscopy. In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.129-135.

ABSTRACT

Drug-Induced Sleep Endoscopy is a modern and effective diagnostic tool used to evaluate dynamic obstructions of the upper airway in patients with obstructive sleep apnea. Traditional endoscopic examinations conducted during wakefulness often fail to accurately reflect the physiological changes occurring during sleep and may lead to incorrect plans regarding the type of surgical intervention. Drug-Induced Sleep Endoscopy, by simulating natural sleep through pharmacologically induced sedation, allows for direct observation of airway collapse and obstructive events in the upper airways. The method was first introduced in 1978 during natural sleep, however now it is performed under sedation using agents such as propofol and midazolam. Standardization efforts, particularly through European consensus reports published in 2014 and updated in 2017, have helped define the procedure’s indications, contraindications, sedation protocols, patient positioning, technical requirements, and safety standards. Drug-Induced Sleep Endoscopy is particularly recommended for patients who are non-compliant with Positive Airway Pressure or Mandibular Advancement Device therapy, and for those with persistent symptoms following surgical interventions. However, nowadays more and more surgeons have been practicing Drug-Induced Sleep Endoscopy even before primary surgery for obstructive sleep apnea. Drug-Induced Sleep Endoscopy also provides valuable insights into the site and pattern of airway obstruction, supporting personalized treatment strategies. Absolute contraindications include high anesthesia risk (ASA IV), pregnancy, and known allergies to sedative agents. The VOTE (Velum, Oropharynx, Tongue base, Epiglottis) classification system offers a standardized approach for evaluating the degree (none, partial, complete) and configuration (anteroposterior, lateral, concentric) of obstruction observed during Drug-Induced Sleep Endoscopy. Critical factors during the procedure include patient positioning, the dosage of sedatives used, depth of sedation, and real-time monitoring of physiological parameters to ensure procedural safety and validity. In conclusion, Drug-Induced Sleep Endoscopy enables detailed anatomical and functional assessment of upper airway obstructions in obstructive sleep apnea patients, improving diagnostic accuracy and contributing to the development of individualized treatment plans.

Keywords: Sleep apnea (obstructive); Continuous positive airway pressure (CPAP); Palate (soft), Oropharynx; Epiglottis, Palatine tonsil

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