A Retrospective Review on the Association Between Drug-Induced Sleep Endoscopy Grading and Polysomnography Findings

Introduction: Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder that may require surgical management and drug-induced sleep endoscopy (DISE) is often used for preoperative evaluation; however, the correlation between DISE findings and the efficacy of recommended surgery is poorly defined. We sought to gain a better understanding of the relationship between DISE findings and surgical success in treating OSA.

Methods: This is a retrospective cohort study at an academic center in the Bronx, New York of patients who underwent DISE prior to surgery for OSA from 2017 to 2023. The primary outcome was the change in the apnea-hypopnea index (AHI) from pre- to post-op polysomnography (PSG). Variables of interest included BMI, OSA therapy, and DISE findings (obstruction severity at the velum, oropharynx, tongue base, and epiglottis). AHI changes were compared with t-tests and ANOVA.

Results: Among 255 patients (mean [SD] age, 42.9 [13.3] years; 63.1% male) who met inclusion criteria, 109 had both a pre- and post-op PSG. The average (SD) AHI change was -13.3 (16.9) events/hr . Surgeries included UPPP in 119 (46.7%) patients, tonsillectomy in 82 (32.2%), Inspire in 44 (17.3), and epiglottectomy in 10 (3.9%). In 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.

Conclusions: Our data show that UPPP benefitted patients with moderate or severe velum or severe oropharynx obstruction, and tonsillectomy benefitted 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.