The role of drug-induced sleep endoscopy and multidisciplinary board evaluation in obstructive sleep apnea syndrome

The treatment of obstructive sleep apnea syndrome (OSAS) is complex, and a significant proportion of failures are present. Multidisciplinary evaluation and treatment become very important to reduce this rate. The aim of this retrospective study was to evaluate the success rate of surgical procedures and oral appliances in two groups of patients with OSAS. One group underwent drug-induced sleep endoscopy (DISE) and a multidisciplinary board evaluation, while the other group did not. Differences between them were analyzed. METHODS: Between 2000 and 2005 (group A), 28 patients underwent surgical treatment, while mandibular advancement device (MAD) was proposed to one subject. Between 2010 and 2015 (group B), after DISE and multidisciplinary board evaluation, 46 underwent surgery and 15 used MAD. All the patients underwent a complete physical examination and fiberoptic pharyngolaryngoscopy with Müller test. After 2010, DISE was suggested for patients who refused or failed continuous positive airway pressure (CPAP) therapy. RESULTS: The mean decrease in AHIwas 60% in group Aand 61% in group B (P>0.05). The success rate was 84% and 82%, respectively (P>0.05). Abetter patient-tailored treatment can be noticed with DISE and multidisciplinary board evaluation. The percentage of septoplasty decreased over time. Moreover, lateral pharyngoplasty was introduced in the clinical practice. Finally, there was a decrease over time of combined nasal and pharyngeal surgery. CONCLUSIONS: Drug-induced sleep endoscopy allows a better identification of the sites of obstruction. In association with multidisciplinary board evaluation, it allows to identify the appropriate therapy for each patient, choosing the procedure that best suits to him