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Updated: Jul 10, 2025

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Obstructive sleep apnea for the rhinologist.
Juan C Nogues1, Nikhita Jain, Courtney T Chou
1Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Obstructive sleep apnea (OSA) management is evolving. Nasal and sinus surgery can improve sleep quality and CPAP tolerance in OSA patients, with special perioperative considerations for rhinologists.
Area of Science:
- Otolaryngology
- Sleep Medicine
- Surgical Innovation
Background:
- Obstructive sleep apnea (OSA) involves upper airway collapse during sleep.
- Otolaryngologists are central to evolving OSA management, including new surgical techniques and devices.
- This review focuses on OSA treatments, particularly for patients undergoing nasal, sinus, and skull base surgery.
Approach:
- Review of current nonsurgical and surgical treatment options for OSA.
- Emphasis on perioperative management for OSA patients undergoing specific head and neck surgeries.
- Discussion of unique considerations for rhinologists managing OSA patients.
Key Points:
- Positive airway pressure (PAP) therapy is first-line, with oral appliances and positional therapy as alternatives.
- Surgical options include pharyngeal/tongue base procedures, hypoglossal nerve stimulation, and skeletal surgery.
- Nasal and sinus surgery can enhance sleep quality and CPAP adherence.
Conclusions:
- OSA patients require special consideration from rhinologists, especially those with moderate to severe OSA undergoing surgery.
- Overnight observation may be beneficial for high-risk OSA patients post-ambulatory surgery.
- CPAP can be resumed perioperatively, with timing dependent on individual patient and surgical factors.

