A Detailed Assessment of Airway Collapse During Sleep
Drug Induced Sleep Endoscopy (DISE) is a specialised investigation used to assess how and where the airway collapses during sleep.
Performed under carefully controlled sedation, DISE allows direct visualisation of the upper airway in a sleep-like state. It provides valuable information that cannot be obtained through examination while awake and is often an important step when considering treatment for obstructive sleep apnoea (OSA), snoring, Inspire therapy, or sleep surgery.
Dr Tom Pepper is a Consultant Oral & Maxillofacial Surgeon in London with specialist expertise in the surgical management of obstructive sleep apnoea. DISE may be used to help identify the most appropriate treatment strategy for each individual patient.
What Is Drug Induced Sleep Endoscopy?
Drug Induced Sleep Endoscopy is a minimally invasive diagnostic procedure performed under light sedation.
A small flexible endoscope is gently passed through the nose while the patient is in a sleep-like state. This allows the surgeon to observe the behaviour of the airway during simulated sleep and identify the areas causing obstruction.
The examination provides a dynamic assessment of:
- The soft palate
- The tongue base
- The lateral pharyngeal walls
- The epiglottis
- Multiple levels of airway collapse
This information helps determine why airflow becomes restricted during sleep and which treatments are most likely to be effective.
Why Is DISE Important?
Obstructive sleep apnoea is often described as a single condition, but the pattern of airway collapse varies significantly between individuals.
Two patients with similar sleep study results may have completely different anatomical causes of obstruction.
An examination performed while awake provides useful information, but it cannot fully reproduce what occurs during natural sleep.
Drug Induced Sleep Endoscopy allows direct visualisation of airway collapse as it occurs in a sleep-like state. As a result, treatment recommendations can be based on the individual’s specific pattern of obstruction rather than on assumptions alone.
This helps improve treatment selection and may reduce the likelihood of ineffective or unnecessary interventions.
Who May Benefit From Drug Induced Sleep Endoscopy?
DISE may be useful for patients with:
- Obstructive sleep apnoea
- Persistent snoring
- Difficulty tolerating CPAP
- Consideration of sleep surgery
- Assessment for Inspire therapy
- Previous unsuccessful sleep apnoea treatment
- Complex or multi-level airway obstruction
It is particularly valuable when surgical treatment is being considered, as it helps identify which structures are contributing most significantly to airway collapse.
DISE and Inspire Therapy
Drug Induced Sleep Endoscopy is an important part of the assessment process for many patients considering Inspire hypoglossal nerve stimulation.
One of the key aims of DISE in this setting is to evaluate the pattern of airway collapse and determine whether it is suitable for Inspire therapy.
Patients with complete concentric collapse at the level of the soft palate are typically less suitable candidates for Inspire treatment. DISE allows this pattern to be identified accurately and helps guide appropriate treatment decisions.
For patients considering Inspire, DISE often represents one of the most important investigations during the assessment process.
DISE and Sleep Surgery
Successful sleep surgery depends upon identifying the structures responsible for airway obstruction.
Drug Induced Sleep Endoscopy helps surgeons understand whether obstruction occurs at:
- The palate
- The tongue base
- The epiglottis
- Multiple airway levels simultaneously
This information may influence decisions regarding:
- Maxillomandibular advancement (MMA)
- Palatal surgery
- Tongue base procedures
- Inspire therapy
- Combination treatments
Because every patient’s airway is different, detailed assessment is essential when planning surgical treatment.
What Happens During the Procedure?
Drug Induced Sleep Endoscopy is usually performed as a day-case procedure.
Following administration of carefully controlled sedation, a flexible endoscope is introduced through the nose to assess the upper airway.
The procedure typically takes only a short period of time and is performed in a monitored environment with an experienced anaesthetic team.
During the examination, the surgeon observes the airway and records the patterns of collapse that occur during sedation. These findings are then reviewed and used to guide treatment recommendations.
Recovery After DISE
Recovery is generally straightforward.
Most patients experience:
- Temporary drowsiness following sedation
- Mild nasal discomfort
- Minimal downtime
Because sedative medication is used, patients should arrange for someone to accompany them home and should avoid driving for the remainder of the day.
Normal activities can usually be resumed quickly following the procedure.
What Are the Risks of DISE?
Drug Induced Sleep Endoscopy is generally considered a low-risk procedure.
Potential risks include:
- Minor nasal discomfort
- Nosebleed
- Temporary sore throat
- Sedation-related complications
Serious complications are uncommon. The risks and benefits of the procedure are discussed in detail during consultation.
Frequently Asked Questions
Does DISE diagnose sleep apnoea?
No. Sleep apnoea is typically diagnosed using a sleep study. DISE is used to understand the anatomical causes of airway obstruction and guide treatment planning.
Is Drug Induced Sleep Endoscopy painful?
The procedure is usually well tolerated. Patients are sedated and generally have little or no recollection of the examination.
How long does a DISE procedure take?
The examination itself is relatively brief, although additional time is required for preparation and recovery.
Do I need DISE before Inspire therapy?
In most cases, yes. DISE is commonly used to assess suitability for Inspire hypoglossal nerve stimulation.
Do I need DISE before sleep surgery?
Not always, but it can provide valuable information about the site and pattern of airway collapse, helping tailor treatment to the individual patient.
Why Choose Dr Tom Pepper for Airway Assessment?
Mr Tom Pepper is a Consultant Oral & Maxillofacial Surgeon with expertise in airway anatomy, facial skeletal surgery and the surgical management of obstructive sleep apnoea.
His background in orthognathic surgery, maxillomandibular advancement surgery and complex facial anatomy provides a detailed understanding of the structures contributing to upper airway obstruction.
DISE findings are interpreted within the context of the individual’s airway anatomy, symptoms, sleep study results and treatment goals to develop a personalised management plan.
Dise in London
For assessment of obstructive sleep apnoea and suitability for comprehensive surgical treatment in London, arrange a consultation to discuss your options.