Airway Changes After Sleep Apnea Surgery Using Drug-Induced Sedation Endoscopy: A Systematic Review and Meta-analysis

To characterize drug-induced sleep endoscopy as a method of evaluating the efficacy of sleep apnea surgical procedures at different airway sites.

PubMed, Scopus, and CINAHL.

Two independent investigators selected studies on sleep apnea surgeries with presurgical and postsurgical drug-induced sedation endoscopy (DISE) evaluations. Primary research studies were included, and data that overlapped with another study were excluded. Investigators performed data extraction, quality rating, and risk-of-bias assessment using the ROBINS-I tool. Data were analyzed using a comparison of proportions and means.

Ultimately, 10 studies (N = 320) were included, with 81.2% male (95% CI: 72.0-88.9), and an average age of 46.8. Significant reductions in VOTE (velum, oropharynx, tongue, and epiglottis) scoring were observed in postsurgical DISE findings at the level of the velum and oropharynx within the palate group (P < .05), and at the velum, oropharynx, and tongue within the maxillomandibular advancement (MMA) group. There were also accompanying reductions in traditional measures such as apnea-hypopnea index (AHI) and Epworth sleepiness score (ESS). No significant reductions in VOTE scores at any level were observed within the nasal surgery group.

DISE allows clinicians a nuanced view in postoperative changes in upper airway collapse patterns and may provide a unique perspective in the evaluation of surgical outcomes in sleep apnea. Further research should be done to correlate these findings to existing outcome measures.