Diagnosing the Level of Obstruction in Patients With Sleep Apnea: Using the Flexible Laryngoscope in the Office Setting

Flexible laryngoscopy is considered an important technique and arguably a more dynamic tool of upper airway evaluation in patients with obstructive sleep apnea (Ref 1). In carefully selected patients, drug-induced sleep endoscopy can be safely performed in the office setting with the special knowledge and skill of the Oral and Maxillofacial Surgeon's special knowledge of IV sedation. Drug-induced sleep endoscopy (DISE) can result in a more specific diagnosis of the level of upper airway collapse, and its severity. This lecture will review the equipment, cost, maintenance of having a flexible laryngoscope, as well as tips to keep the cost down while still being able to record images using novel technique such as an iPhone adapter. In addition, the anesthetic technique of DISE as performed at my facility will be reviewed along with pre-procedure and post-procedure instructions, medications, avoiding potential complications and medical-legal issues.

1) Kezirian EJ1, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol. 2011 Aug;268(8):1233-6. doi: 10.1007/s00405-011-1633-8. Epub 2011 May 26.  

2) Certal VF, Pratas, Guimarães, Lugo, Tsou, Camacho, Capasso.  Awake examination versus DISE for surgical decision making in patients with OSA: A systematic review. Laryngoscope. 2015 Oct 20. doi: 10.1002/lary.25722.