European position paper on drug-induced sedation endoscopy (DISE)

Background Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstruc- tive sleep apnea hypopnea syndrome (OSAHS), many con- troversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discus- sion during a recent dedicated meeting. Methods The authors have evaluated all the available evi- dence reported in the literature and have compared experience among various departments in leading European centers in order to provide a standardization of the DISE procedure and an in-depth insight in the main aspects of this technique. Results A proposal of the DISE procedure standardization has been achieved with a general agreement concerning the ter- minology, indications, contraindications, required preliminary examinations, setting, technical equipment required, staffing, local anesthesia and nasal decongestion, patient positioning, basis and special diagnostic maneuvers, and the applied seda- tion drugs and observation windows. Otherwise, no consensus has been reached on a scoring and classification system. Conclusions Although consensus has been reached on several aspects of the DISE procedure, some topics remain open to future research, such as a better analysis of the importance of positional aspects during DISE and a further comparison of the differences in degree, level and pattern of upper airway collapse observed during DISE versus during natural sleep and awake endoscopy. Finally, a universally accepted scoring and classification system is lacking.