What is Sleep Endoscopy?
Sleep endoscopy, also referred to as drug-induced sleep endoscopy (DISE) or sleep nasoendoscopy (SNE), is a diagnostic procedure performed using an endoscope (a diagnostic tool) to evaluate the upper airway of patients with snoring and obstructive sleep apnea (OSA) in conditions that are similar to natural sleep.
Effective treatment for snoring and sleep apnea depends on the precise identification of the airway obstruction pattern. In the throat, there are 4 important regions that can be responsible: palate (velum), lateral pharyngeal wall (oropharynx), tongue, and epiglottis. Accurate diagnosis enables your physician to provide targeted and successful treatment. During sleep endoscopy, as you start snoring and experience obstruction in your breathing, your physician will pass an endoscope - a thin, long, flexible tube with a light and a tiny camera at one end - through one side of your nose in order to assess your throat and notice the specific areas and airway obstruction patterns in real-time for accurate analysis.
Indications for Sleep Endoscopy
Sleep endoscopy procedure is typically recommended for individuals with a history of severe snoring or documented obstructive sleep apnea to recommend suitable treatment. Sleep endoscopy can be useful in:
- Accurately identifying the location of obstruction
- Predicting response to CPAP, oral appliance, and surgery
- Evaluation of nasal breathing versus mouth breathing
- Demonstrating factors that interfere with the use of CPAP
- Individuals who are considering surgery for the first time
- Individuals who have not obtained ideal results after previous procedures
Contraindications for Sleep Endoscopy
Not all individuals with OSA are qualified to undergo sleep endoscopy. Following is a list of individuals not suitable to undergo sleep endoscopy:
- Patients with an allergy to propofol - the sedative medicine used during sleep endoscopy
- Pregnant women
- Patients with a weak or unsafe airway
- Individuals with a history of aspiration (inhaling a foreign object such as sucking food into the airway)
- Individuals with allergies to components of propofol, such as soybean oil or egg lecithin
- Individuals with a considerable nasal obstruction that impedes the passage of an endoscope
Preparation for Sleep Endoscopy
Usually, no special preparations are required for sleep endoscopy procedure. You should be able to eat and drink normally before the procedure. Tell your physician if you are on any medications such as blood thinners as you may need to temporarily stop taking these medications. You should also inform if you are allergic to propofol or components of propofol.
Procedure for Sleep Endoscopy
Sleep endoscopy is a simple outpatient procedure, meaning you can go home the same day as your procedure. In general, the procedure involves the following steps:
- You will be asked to lie down on the procedure table in a supine (face-up) position.
- A nasal decongestant may be sprayed into your nose to reduce any nasal membrane swelling and facilitate easy passage of the endoscope.
- An anesthetic may also be sprayed into your nose to briefly numb the nose and help minimize any discomfort while the endoscope is passed through the nose.
- A sedative medicine called propofol is then administered by your anesthesiologist to keep you sedated in a way that mimics natural sleep.
- After confirming that you are sedated and breathing, your physician will pass an endoscope through one of the nostrils and into the throat to evaluate the entire upper airway and nearby structures that may possibly be causing snoring or obstructive sleep apnea.
- The thin endoscopic tube attached with a light source and a high-definition video camera at its end transmits images of the specific sites of obstruction to an external monitor for your physician to view.
- The information obtained will help determine which specific structures seem to be playing a key role in airway obstruction/snoring and which treatment option would provide the best result.
Post-Procedure Care and Recovery
Sleep endoscopy often provides the information required to create a treatment plan for OSA or snoring. You may discuss this with your physician right after your procedure. You may feel pain or discomfort in the nose and throat as a result of the endoscope being passed. Medications are provided as needed to address any discomfort. If you had your sleep endoscopy in the office, you should be able to go home right after the procedure. You should also be able to go about your daily activities as usual. However, you are advised not to drive or operate heavy machinery for 24 hours as you have received sedative medicine for the procedure. You should arrange for someone to drive you home. You should follow all your physician’s instructions about medications and follow-up.
Risks and Complications
Sleep endoscopy is a relatively safe procedure; however, as with any procedure, some risks and complications may occur, such as:
- Aspiration
- Laryngospasm (muscle spasm of the vocal cords)
- Epistaxis (nose bleeding)
- Allergic reactions
- Pain or discomfort in the nose/throat
