A Retrospective Review on the Association Between Drug-Induced Sleep Endoscopy Findings and Surgical Outcomes.

Abstract

We aim to gain a better understanding of the relationship between drug-induced sleep endoscopy (DISE) findings and surgical success. This is a retrospective cohort study of patients who underwent DISE before surgery from 2017 to 2023. The primary outcome was the change in apnea-hypopnea index (AHI) from pre-op to post-op polysomnography (PSG). Variables of interest included obstructive sleep apnea therapy and DISE findings. AHI changes were compared with t tests and analysis of variance (ANOVA). Tertiary academic center. Retrospective chart review. In total, 255 patients met the inclusion criteria; 109 had both a pre-op and post-op PSG. The average (SD) AHI change was -13.3 (16.9) events/h. In uvulopalatopharyngoplasty (UPPP) patients, there was a significant AHI decrease in those with moderate (mean, -9.8; 95% CI, -18.0 to -1.7) or severe (mean, -7.6; 95% CI, -13.2 to -2.1) velum or severe (mean, -12.2; 95% CI, -19.8 to -4.6) oropharynx obstruction. In tonsillectomy patients, there was a significant AHI decrease for moderate (mean, -17.1; 95% CI, -33.1 to -1.1) or severe (mean, -19.7; 95% CI, -29.0 to -10.3) oropharynx obstruction. In Inspire patients, there was a significant AHI decrease regardless of tongue base or epiglottic obstruction on DISE. Our data show that UPPP benefited patients with moderate or severe velum or severe oropharynx obstruction, and tonsillectomy benefited those with moderate or severe oropharynx obstruction. There was no significant association between DISE findings and AHI change for Inspire. Our findings emphasize the importance of preoperative analysis in identifying the optimal surgical approach.