Presentation (CTI)

OBJECTIVES: This review aimed to evaluate the clinical safety and effectiveness of drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea (OSA), focusing on complications and adverse events as safety outcomes, and on improvements in apnea indices and treatment success rates as effectiveness outcomes.
METHODS: A systematic literature search was conducted across six databases (Ovid-MEDLINE, Ovid-EMBASE, Cochrane, KoreaMed, KMbase, and RISS) as of April 2024. Comparative studies were included if DISE was performed in addition to standard awake evaluation (e.g., physical exam or Muller maneuver) in the intervention group, while the control group received only the awake evaluation. Risk of bias was assessed using the Cochrane RoB tool for randomized controlled trials and RoBANS 2.0 for nonrandomized studies. Meta-analyses were conducted when feasible. Two reviewers independently performed all steps and resolved disagreements by consensus.
RESULTS: Fourteen studies (3 RCTs and 11 NRSs; N = 1,454) were included. Two studies assessed safety and reported no adverse events related to DISE. Among 11 studies reporting AHI or RDI, meta-analyses showed no significant differences between DISE and non-DISE groups (RCT: MD -1.79, 95 percent CI -4.88 to 1.30; NRS: SMD -0.25, 95 percent CI -0.55 to 0.04). Subgroup analyses suggested improved respiratory indices when DISE was added to physical exams, particularly in supine-position assessments and in patients using intraoral devices. Findings on lowest oxygen saturation and treatment success also showed no significant differences, though some findings had substantial heterogeneity.
CONCLUSIONS: Although the evidence is limited, DISE appears to be a safe method and may support treatment planning for OSA patients who cannot tolerate or do not respond to positive airway pressure (PAP) therapy. Further studies are needed to confirm its usefulness and value.