Sleep Endoscopy: How Sleep Endoscopy Works for the Diagnosis of Obstructive Sleep Apnea

Sleep Endoscopy, also known as Drug-Induced Sedation Endoscopy (DISE), is a diagnostic procedure used to observe the upper airways during sleep.

The upper airways include all respiratory organs outside the chest, namely:

• nasal cavities;
• paranasal cavities;
• pharynx;
• larynx.

Sleep endoscopy precisely identifies obstruction areas in these parts of the respiratory system that cause apneas and hypopneas—partial or complete reductions in airflow—during sleep.

Unlike traditional endoscopic techniques for assessing the upper airways, this diagnostic method provides a direct and comprehensive view of the upper airways under pharmacologically induced sleep.

As such, this procedure offers detailed information that cannot be obtained through other traditional diagnostic methods, making it an innovative and personalized tool in diagnosing and managing sleep respiratory disorders.

“This procedure is especially useful for moderate to severe Obstructive Sleep Apnea Syndrome (OSAS) cases, particularly when the patient cannot tolerate CPAP therapy, which has a tolerability rate of about 50%,” explains Dr. Sorrenti.

“Sleep endoscopy helps identify the most appropriate treatment, which may be surgical or involve a mandibular advancement device (bite). In some cases, combined therapy is used: surgery stabilizes the pharyngeal walls, while the mandibular advancement device prevents the tongue from falling back.”

Sleep endoscopy is carried out under a short period of sedation with continuous monitoring of all vital parameters. Specific medications are used to induce a sleep state similar to natural rest.

Once the patient is asleep, the ENT specialist inserts a flexible endoscope with a camera through the nasal cavities to visualize the upper airways.

The specialist observes, in real time, how the different segments of the upper airways behave, quickly identifying any issues such as hypertrophy, narrowing, or collapses that may cause respiratory obstruction symptoms in patients with Obstructive Sleep Apnea Syndrome (OSAS).

“Sleep Endoscopy,” explains the specialist, “is an endoscopic examination of the upper airways conducted with a fiber-optic scope while the patient is asleep under pharmacological sedation, as natural sleep is difficult to achieve in a clinical setting.

During the procedure, the patient is sedated via an intravenous injection administered by an anesthesiologist, who continuously monitors brain activity with an electroencephalogram. This sedation helps simulate sleep as closely as possible to avoid distortions that might otherwise affect the results.

Observing the airways during sleep is essential because muscle tone changes in this state, potentially revealing obstructions that may not be visible when the patient is awake and the airway muscles are functioning normally. This examination precisely identifies obstructed areas, such as the pharyngeal walls, the base of the tongue, and the epiglottis, which may require surgical correction.”

Sleep endoscopy offers numerous advantages for diagnosing Obstructive Sleep Apnea Syndrome (OSAS), including:

• Precise diagnosis: Specialists gain a clear view of the exact location of the obstruction in the airway.
• Personalized treatment: Physicians can develop targeted treatments focused on the specific areas affected by the condition.
• Improved quality of life: Accurate and timely diagnosis allows for optimal treatment choices, which enhances the patient’s overall quality of life.

Despite these many benefits, sleep endoscopy does have some limitations:

• Risks associated with anesthesia: The use of sedative drugs may involve certain risks.
• Limited view of the pharynx in a supine position: The procedure is conducted while the patient is lying down, which may not fully represent the natural airway dynamics during sleep in other positions.

The Otolaryngology Unit at Villa Erbosa offers a specialized service for the treatment of Obstructive Sleep Apnea Syndrome (OSAS).

This service provides a comprehensive diagnostic pathway to identify the most effective, personalized therapy and includes:

• Otolaryngology consultation
• Endoscopic examination of the upper airways
• Polysomnography
• Sleep Endoscopy

Obstructive Sleep Apnea Syndrome (OSAS) is a common condition affecting approximately 30% of the global adult population.

This sleep disorder is characterized by recurring interruptions in normal breathing during sleep. These interruptions, known as apneas, occur due to partial or complete collapse of the upper airways, which blocks the natural flow of inhaled and exhaled air.

The main symptoms of Obstructive Sleep Apnea Syndrome include:

• loud and persistent snoring;
• apneas, or pauses in breathing during sleep;
• daytime sleepiness;
• repeated awakenings during the night, sometimes with a sensation of choking or difficulty breathing;
• feeling unrested despite adequate sleep duration;
• morning headaches and head pain upon waking;
• difficulty concentrating and memory problems;
• irritability and mood changes;
• increased blood pressure;
• dry or sore throat upon waking.

Typically marked by repeated episodes of breathing obstruction in the airways during sleep, this syndrome can lead to serious health consequences, such as:

• cardiovascular diseases;
• hypertension;
• diabetes;
• daytime sleepiness and reduced quality of life.

Thus, a precise and targeted diagnosis is essential for early detection of this condition.