Successful treatment of snoring, obstructive sleep apnea (OSA), and other forms of sleep-disordered breathing depends on understanding where and how the upper airway is narrowing or collapsing during sleep.
A traditional examination can provide valuable information about airway anatomy while a patient is awake. However, the behavior of the airway can change during sleep as muscle tone decreases and breathing dynamics change.
Drug-Induced Sleep Endoscopy (DISE) allows Dr. Soroush Zaghi to directly observe the upper airway while a patient is sedated in a sleep-like state. This dynamic evaluation can help identify the specific sites and patterns of airway obstruction and provide additional information for individualized treatment planning.
Identifying Airway Obstruction During Sleep
Successful treatment of snoring, obstructive sleep apnea (OSA), and other forms of sleep-disordered breathing depends on understanding where and how the upper airway is narrowing or collapsing during sleep.
A traditional examination can provide valuable information about airway anatomy while a patient is awake. However, the behavior of the airway can change during sleep as muscle tone decreases and breathing dynamics change.
Drug-Induced Sleep Endoscopy (DISE) allows Dr. Soroush Zaghi to directly observe the upper airway while a patient is sedated in a sleep-like state. This dynamic evaluation can help identify the specific sites and patterns of airway obstruction and provide additional information for individualized treatment planning.
Drug-Induced Sleep Endoscopy, commonly called DISE, is a procedure used to evaluate the upper airway in patients with obstructive sleep apnea, snoring, or other sleep-related breathing concerns.
During DISE, sedation is administered while the patient’s breathing and airway are monitored. Once the appropriate level of sedation is achieved, Dr. Zaghi passes a thin, flexible endoscope through the nose.
The camera allows the upper airway to be observed dynamically as the patient breathes.
Rather than evaluating airway structures only while the patient is awake, DISE provides information about where, how, and to what degree the airway narrows or collapses during a sleep-like state.
Upper-airway obstruction can be complex.
Some patients have a single dominant area of obstruction, while others experience narrowing or collapse at multiple levels of the airway.
A sleep study can provide important information about the presence and severity of sleep-disordered breathing, but it does not necessarily show which anatomical structures are contributing to obstruction.
DISE provides a different type of information by allowing the airway itself to be visualized dynamically.
The findings may help the treatment team better understand the patient’s individual pattern of obstruction and determine which treatment options warrant consideration.
During sleep endoscopy, several major regions of the upper airway can be examined.
Palate / Velum
The velum, or soft palate, can narrow or collapse during sleep and may contribute to snoring and airway obstruction.
DISE allows the movement and pattern of palatal obstruction to be observed.
Lateral Pharyngeal Walls / Oropharynx
The lateral pharyngeal walls form the sides of the throat.
In some patients, these tissues move inward during sleep and contribute to narrowing or collapse of the airway.
Tongue Base
The position of the tongue and tongue base can affect the amount of available space within the upper airway.
During DISE, Dr. Zaghi can evaluate whether posterior movement or collapse involving the tongue contributes to obstruction.
Epiglottis
The epiglottis is a structure located near the entrance to the larynx.
In certain patients, movement or collapse involving the epiglottis may contribute to sleep-related airway obstruction.
Multilevel Airway Obstruction
Not every patient has obstruction in only one location.
DISE may reveal that several structures contribute to airway narrowing at the same time. Identifying multilevel obstruction can be particularly important when developing an individualized treatment strategy.
Drug-Induced Sleep Endoscopy is performed under monitored sedation.
Medication is administered to create an appropriate sleep-like state while the patient is carefully monitored.
Once the appropriate level of sedation is achieved, a thin, flexible endoscope is gently passed through one side of the nose.
Dr. Zaghi observes the upper airway while the patient breathes, evaluating the movement of the palate, throat, tongue, epiglottis, and other relevant structures.
The location, pattern, and extent of airway narrowing or collapse are assessed.
The DISE findings are considered alongside the patient’s sleep study, symptoms, physical examination, medical history, and previous treatment response to help guide recommendations.
A sleep study and DISE provide different but potentially complementary information.
A sleep study evaluates physiological events occurring during sleep and can provide measurements such as the frequency of apneas, hypopneas, oxygen changes, and other sleep-related findings depending on the type of study performed.
DISE focuses on airway anatomy and dynamic obstruction.
In simple terms:
Sleep Study: Helps determine what is happening to breathing during sleep.
DISE: Helps investigate where and how the upper airway may be obstructing during a sleep-like state.
One does not necessarily replace the other.
The purpose of DISE is not simply to identify airway obstruction. The findings can provide additional information when evaluating potential treatment options.
Depending on the individual patient, DISE findings may contribute to decisions involving:
Not every treatment is appropriate for every pattern of obstruction.
By identifying the structures that appear to contribute to airway narrowing or collapse, DISE can help support a more targeted treatment strategy.
For patients who have difficulty using CPAP, DISE may provide additional information about upper-airway behavior and factors that could be contributing to treatment challenges.
This information can be considered alongside mask fit, pressure settings, nasal obstruction, patient comfort, and other factors affecting CPAP tolerance.
Oral appliances typically reposition the lower jaw and/or associated structures to help maintain airway space during sleep.
During DISE, airway response to certain positional maneuvers may provide useful information when considering whether an oral appliance could be appropriate.
When surgery is being considered, understanding the location and pattern of airway collapse can be particularly valuable.
For example, a patient whose obstruction predominantly involves the palate may require a different treatment strategy from a patient with significant tongue-base, lateral-wall, epiglottic, or multilevel collapse.
DISE findings are therefore considered as one component of comprehensive surgical planning.
DISE may be considered for selected patients with:
Whether DISE is appropriate should be determined through an individualized clinical evaluation.
There is rarely a one-size-fits-all solution for sleep-related breathing disorders.
At The Breathe Institute, information from DISE can be considered together with:
Bringing these findings together can provide a more complete understanding of the patient’s sleep and breathing concerns.
DISE stands for Drug-Induced Sleep Endoscopy. It is a procedure that uses monitored sedation and a flexible endoscope to dynamically evaluate the upper airway during a sleep-like state.
No. A sleep study evaluates physiological events associated with sleep and breathing, while DISE allows the healthcare team to directly visualize the pattern and location of upper-airway narrowing or collapse.
Patients receive sedation to create an appropriate sleep-like state for airway evaluation. The procedure is performed with appropriate monitoring.
A thin, flexible endoscope is passed through the nose so the physician can examine the upper airway.
DISE can help evaluate obstruction involving areas such as the soft palate or velum, lateral pharyngeal walls, tongue base, and epiglottis. Some patients have obstruction at more than one level.
DISE can provide valuable information that helps guide treatment selection, but it does not guarantee the outcome of a particular treatment. Findings should be interpreted alongside the patient’s sleep study, examination, symptoms, and other clinical information.
It may be useful in selected patients who have difficulty with CPAP, particularly when additional information about airway behavior could help guide treatment planning.
Not necessarily. Although DISE can be particularly useful when planning sleep apnea surgery, its findings may also provide information relevant to other treatment approaches in appropriately selected patients.
Understanding where and how the upper airway becomes obstructed can be an important part of developing an individualized treatment plan for obstructive sleep apnea and other sleep-related breathing concerns.
Schedule a consultation with Dr. Soroush Zaghi and The Breathe Institute to learn whether Drug-Induced Sleep Endoscopy may be appropriate as part of your sleep and airway evaluation.
Dr. Zaghi and The Breathe Institute offer virtual screenings for patients seeking expert guidance on nasal obstruction, snoring, sleep apnea, tongue-tie, and breathing-related concerns
If you or your child is experiencing persistent snoring, mouth breathing, nasal obstruction, sleep-disordered breathing, tongue mobility concerns, or other airway-related symptoms, a comprehensive evaluation can help identify potential contributing factors and appropriate next steps.
