Drug Induced Sleep Endoscopy (DISE) has been used as part of the evaluation of patients with sleep apnea for over 30 years. DISE is performed to assess the airway with patients in a state of artificial sleep. The procedure is perform in the operating room using twilight anesthesia – similar to a colonoscopy. The surgeon evaluates the airway and creates a surgical plan based on the findings. Evaluation of the airway under sedation has been shown to reveal areas of obstruction at the back of the tongue and voice box that are not seen during the office examination. These observations can dramatically influence the type of surgery that may be recommended. DISE can also determine whether you are a candidate for surgery.
Patients with obstructive sleep apnea can be categorized as mild, moderate, or severe based on the results of a sleep study. For patients with mild OSA the obstruction is usually due to obstruction at one site (large tonsils, nasal congestion). For patients with moderate to severe OSA the pattern of obstruction is typically more complex, involving the nose, palate, and tongue. In some cases the jaw may also be factor in patients with a an overbite. Sites of obstruction are initially identified in the office and then confirmed in the operating room during sedated endoscopy (DISE). The surgeon will formulate a treatment strategy based on the accumulated evidence including office exam, DISE, sleep study, and an x-ray of the jaw. Multilevel surgery has been found to improve the chances of success in patients with moderate to severe OSA. The surgery may be done in stages to best optimize results. Go to Hoffroboticsurgery.com for details.
Patients with sleep apnea who are intolerant of traditional therapy such as CPAP or those who have failed other treatment modalities may be candidates for the Inspire hypoglossal nerve stimulator. This device is similar to a pacemaker. A device is implanted in the chest that detects pauses in breathing and provides stimulation to the tongue muscle, preventing it from falling back and blocking the air passage. This device has been approved by the FDA and thousands of patients have undergone this surgery around the world. St. Joseph Mercy Health System is one of three hospitals in the Michigan performing this surgery. In order to be a candidate, patients must have body mass index (BMI) of 32 or less and have moderate to severe sleep apnea. In addition, patients considering this procedure will need to undergo a sleep endoscopy (DISE) to establish candidacy. The inspire device has cure rates of over 50% with more than 70% of patients able to discontinue CPAP. Snoring resolves in over 85% of patients. Better yet, 85% of patients continue to use the device after 3 years. For more information, go to https://www.inspiresleep.com.