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

doi:10.1002/lary.27655

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

Otolaryngology

Research output: Contribution to journal › Article › peer-review

72 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	761-770
Number of pages	10
Journal	Laryngoscope
Volume	129
Issue number	3
DOIs	https://doi.org/10.1002/lary.27655
State	Published - 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.

Keywords

Surgery
drug-induced sleep endoscopy
endoscopy
obstructive
sleep apnea

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10.1002/lary.27655

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Green, K. K., Kent, D. T., D'Agostino, M. A., Hoff, P. T., Lin, H. S., Soose, R. J., Boyd Gillespie, M., Yaremchuk, K. L., Carrasco-Llatas, M., Tucker Woodson, B., Jacobowitz, O., Thaler, E. R., Barrera, J. E., Capasso, R., Liu, S. Y., Hsia, J. C., Mann, D., Meraj, T. S., Waxman, J. A., & Kezirian, E. J. (2019). Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study. Laryngoscope, 129(3), 761-770. https://doi.org/10.1002/lary.27655

Green, KK, Kent, DT, D'Agostino, MA, Hoff, PT, Lin, HS, Soose, RJ, Boyd Gillespie, M, Yaremchuk, KL, Carrasco-Llatas, M, Tucker Woodson, B, Jacobowitz, O, Thaler, ER, Barrera, JE, Capasso, R, Liu, SY, Hsia, JC, Mann, D, Meraj, TS, Waxman, JA & Kezirian, EJ 2019, 'Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study', Laryngoscope, vol. 129, no. 3, pp. 761-770. https://doi.org/10.1002/lary.27655

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title = "Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study",

abstract = " 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.",

keywords = "Surgery, drug-induced sleep endoscopy, endoscopy, obstructive, sleep apnea",

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

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: {\textcopyright} 2018 The American Laryngological, Rhinological and Otological Society, Inc.",

year = "2019",

month = mar,

doi = "10.1002/lary.27655",

language = "English (US)",

volume = "129",

pages = "761--770",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "John Wiley and Sons Inc.",

number = "3",

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TY - JOUR

T1 - Drug-Induced Sleep Endoscopy and Surgical Outcomes

T2 - A Multicenter Cohort Study

AU - Green, Katherine K.

AU - Kent, David T.

AU - D'Agostino, Mark A.

AU - Hoff, Paul T.

AU - Lin, Ho Sheng

AU - Soose, Ryan J.

AU - Boyd Gillespie, M.

AU - Yaremchuk, Kathleen L.

AU - Carrasco-Llatas, Marina

AU - Tucker Woodson, B.

AU - Jacobowitz, Ofer

AU - Thaler, Erica R.

AU - Barrera, José E.

AU - Capasso, Robson

AU - Liu, Stanley Yung

AU - Hsia, Jennifer C

AU - Mann, Daljit

AU - Meraj, Taha S.

AU - Waxman, Jonathan A.

AU - Kezirian, Eric J.

N1 - 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.

PY - 2019/3

Y1 - 2019/3

N2 - 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.

AB - 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.

KW - Surgery

KW - drug-induced sleep endoscopy

KW - endoscopy

KW - obstructive

KW - sleep apnea

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

Abstract

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Keywords

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