Andrea De Vito1,2, Marina Carrasco Llatas3, Madeline J Ravesloot4,5, Bhik Kotecha6, Nico De Vries7,8,9, Evert Hamans10, Joachim Maurer11, Marcello Bosi12, Marc Blumen13, Clemens Heiser14, Michael Herzog15, Filippo Montevecchi16, Ruggero Massimo Corso17, Alberto Braghiroli18, Riccardo Gobbi1, Anneclaire Vroegop19, Patty Elisabeth Vonk4, Winfried Hohenhorst20, Ottavio Piccin21, Giovanni Sorrenti21, Olivier M Vanderveken22, Claudio Vicini23,24,25,26,27. 1. Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy. 2. ENT Unit, Santa Maria delle Croci Hospital, Ravenna AUSL of Romagna, Romagna, Italy. 3. ENT Clinic, Hospital Universitario Doctor Peset, Valencia, Spain. 4. Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands. 5. Medisch Centrum Jan van Goyen, Amsterdam, The Netherlands. 6. Royal National Throat Nose & Ear Hospital, UCLH, London, UK. 7. Department of Otolaryngology, OLVG Hospital and ACTA, Amsterdam, Netherlands. 8. Department of Otorhinolaryngology and Head and Neck Surgery, Multidisciplinary Sleep Disorders Center, University of Antwerp, Antwerp, Belgium. 9. Department of Oral Kinesiology, Academic Centre for Dentistry, MOVE Inst., Amsterdam, The Netherlands. 10. Department of Otorhinolaryngology, Head and Neck Surgery, Jan Palfijn Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerpen, Belgium. 11. Sleep Disorders Centre, Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Mannheim, Mannheim, Germany. 12. Pulmonary Operative Unit, Department of Thoracic Diseases, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy. 13. Service ORL, Hopital Foch, Suresnes France and Centre Medical Veille Sommeil, Paris, France. 14. Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universitat Munchen, Munich, Germany. 15. Department of Otorhinolaryngology, Head and Neck Surgery, Carl Thiem Klinikum, Cottbus, Germany. 16. Head and Neck Department, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy. 17. Intensive Care Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy. 18. Sleep Lab. Pulmonary Rehabilitation Dept. Istituti Clinici Scientifici Maugeri, SPA SB, IRCCS, Veruno, Italy. 19. Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium. 20. ENT, Head and Neck Surgery, Alfried Krupp Hospital, Essen, Germany. 21. Department of Otolaryngology, Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy. 22. Faculty of Medicine and Health Sciences, University of Antwerp- Department ENT, Head and Neck Surgery, Antwerp University Hospital - Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium. 23. Head and Neck Department, AUSL of Romagna, ENT & Oral Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy. 24. ENT Unit, Infermi Hospital, AUSL of Romagna, Faenza, Italy. 25. ENT Unit, Santa Maria delle Croci Hospital, Ravenna, Italy. 26. AUSL of Romagna, Romagna, Italy. 27. ENT Clinic, University of Ferrara, Ferrara, Italy.
Abstract
BACKGROUND: The first edition of the European position paper (EPP) on drug-induced sleep endoscopy (DISE) was published in 2014 with the aim to standardise the procedure, to provide an in-depth insight into the main aspects of this technique and to have a basis for future research. Since 2014, new studies have been published concerning new sedative agents or new insights into the pattern/levels of the obstruction depending on the depth of sedation. Therefore, an enlarged group of European experts in the field of sleep breathing disorders (SBD), including the most of the first DISE EPP main authors, has decided to publish an update of the European position paper on DISE, in order to include new evidence and to find a common language useful for reporting the findings of this endoscopic evaluation in adult population affected by SBD. METHODS: The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centres in order to provide an update regarding the standardisation of the DISE procedure and an in-depth insight into the main aspects of this technique. RESULTS: After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued.
BACKGROUND: The first edition of the European position paper (EPP) on drug-induced sleep endoscopy (DISE) was published in 2014 with the aim to standardise the procedure, to provide an in-depth insight into the main aspects of this technique and to have a basis for future research. Since 2014, new studies have been published concerning new sedative agents or new insights into the pattern/levels of the obstruction depending on the depth of sedation. Therefore, an enlarged group of European experts in the field of sleep breathing disorders (SBD), including the most of the first DISE EPP main authors, has decided to publish an update of the European position paper on DISE, in order to include new evidence and to find a common language useful for reporting the findings of this endoscopic evaluation in adult population affected by SBD. METHODS: The authors have evaluated all the available evidence reported in the literature and have compared experience among various departments in leading European centres in order to provide an update regarding the standardisation of the DISE procedure and an in-depth insight into the main aspects of this technique. RESULTS: After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued.
Authors: C Janott; M Schmitt; C Heiser; W Hohenhorst; M Herzog; M Carrasco Llatas; W Hemmert; B Schuller Journal: HNO Date: 2019-09 Impact factor: 1.284
Authors: Clara H Lee; Everett G Seay; Benjamin K Walters; Nicholas J Scalzitti; Raj C Dedhia Journal: J Clin Sleep Med Date: 2019-08-15 Impact factor: 4.062
Authors: Claudio Vicini; Andrea De Vito; Giannicola Iannella; Riccardo Gobbi; Ruggero Massimo Corso; Filippo Montevecchi; Antonella Polimeni; Marco De Vincentiis; Giuseppe Meccariello; Giovanni D'agostino; Giovanni Cammaroto; Francesco Stomeo; Giuseppe Magliulo Journal: Eur Arch Otorhinolaryngol Date: 2018-10-13 Impact factor: 2.503
Authors: Patty E Vonk; Julia A M Uniken Venema; Aarnoud Hoekema; Madeline J L Ravesloot; Johanna A van de Velde-Muusers; Nico de Vries Journal: J Clin Sleep Med Date: 2020-07-15 Impact factor: 4.062