Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

Katherine K. Green, David T. Kent, Mark A. D'Agostino, Paul T. Hoff, Ho Sheng Lin, Ryan J. Soose, M. Boyd Gillespie, Kathleen L. Yaremchuk, Marina Carrasco-Llatas, B. Tucker Woodson, Ofer Jacobowitz, Erica R. Thaler, José E. Barrera, Robson Capasso, Stanley Yung Liu, Jennifer C Hsia, Daljit Mann, Taha S. Meraj, Jonathan A. Waxman, Eric J. Kezirian

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12 Scopus citations


Objective: To evaluate the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort. Methods: Retrospective, multi-center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression. Results: Two hundred seventy-five study participants were included from 14 centers. Mean age was 51.4 ± 11.8 years, and body mass index was 30.1 ± 5.2 kg/m 2 . There was moderate interrater reliability (kappa = 0.40–0.60) for DISE findings. Oropharyngeal lateral wall-related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue-related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum-related obstruction or the degree of epiglottis-related obstruction. Surgical response was associated with tonsil size and body mass index (inversely). Conclusion: DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation technique. Level of Evidence: 2B Laryngoscope, 129:761–770, 2019.

Original languageEnglish (US)
Pages (from-to)761-770
Number of pages10
Issue number3
StatePublished - Mar 2019

Bibliographical note

Funding Information:
The study was supported by a Focused Projects Award from the American Sleep Medicine Foundation. This publication was also supported by the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health (NIH), grants UL1TR001855 and UL1TR000130. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Publisher Copyright:
© 2018 The American Laryngological, Rhinological and Otological Society, Inc.


  • Surgery
  • drug-induced sleep endoscopy
  • endoscopy
  • obstructive
  • sleep apnea


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