Drug induced sedated sleep endoscopy (DISE) is often employed to determine the site, severity and pattern of obstruction in patients with sleep apnea. DISE is usually performed in supine position. We recently showed that the obstruction pattern is different when DISE is performed in lateral position. In this study, we compared the outcomes of DISE performed in supine position with head rotated, with the outcomes of DISE performed with head and trunk in lateral position. The Prospective study design was used in the present study. Sixty patients with OSA (44 male; mean apnea hypopnea index (AHI) 20.8 ± 17.5 events/h) underwent DISE under propofol sedation. Patients were placed in lateral position, and the upper airway collapse was evaluated. The patients were then placed in supine position with the head rotated to the right side. DISE outcomes were scored using the VOTE classification system. In lateral position, nine patients (15.0 %) had a complete antero-posterior (A-P) collapse at the level of the velum, nine had a partial A-P collapse. During head rotation and trunk in supine position, at the level of the velum, four patients (6.7 %) had a complete A-P collapse, while two patients (3.3 %) had a partial A-P collapse. For all other sites, the patterns of collapse were not significantly different between head rotation and lateral position. During DISE, rotation of the head in supine position, and lateral head and trunk position present similar sites, severity and patterns of upper airway collapse, with the exception of collapse at the level of the velum. Here the severity of A-P collapse is less severe during head rotation than in lateral head and trunk position.


  1. Maurer JT, Van de Heyning P, Lin H-S et al (2012) Operative technique of upper airway stimulation: an implantable treatment of obstructive sleep apnea. Oper Tech Otolaryngol Neck Surg 23:227–233
  2. Koutsourelakis I, Safiruddin F, Ravesloot M et al (2012) Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome. Laryngoscope 122:2587–2591. doi:10.1002/lary.23462
  3. Azagra-Calero E, Espinar-Escalona E, Barrera-Mora J-M et al (2012) Obstructive sleep apnea syndrome (OSAS): review of the literature. Med Oral Patol Oral Cir Bucal 17:e925–e929
  4. Hamans E, Stuck BA, de Vries N et al (2013) Hyoid expansion as a treatment for obstructive sleep apnea: a pilot study. Sleep Breath 17:195–201. doi:10.1007/s11325-012-0673-7
  5. Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1:862–865
  6. Van de Heyning PH, Badr MS, Baskin JZ et al (2012) Implanted upper airway stimulation device for obstructive sleep apnea. Laryngoscope 122:1626–1633. doi:10.1002/lary.23301
  7. Van Maanen JP, Richard W, Van Kesteren ER et al (2012) Evaluation of a new simple treatment for positional sleep apnoea patients. J Sleep Res 21:322–329. doi:10.1111/j.1365-2869.2011.00974.x
  8. Van Maanen JP, Meester KAW, Dun LN et al (2013) The sleep position trainer: a new treatment for positional obstructive sleep apnoea. Sleep Breath 17:771–779. doi:10.1007/s11325-012-0764-5
  9. Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268:1233–1236. doi:10.1007/s00405-011-1633-8
  10. Ravesloot MJL, de Vries N (2011) One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope 121:2710–2716. doi:10.1002/lary.22369
  11. Safiruddin F, Koutsourelakis I, de Vries N (2014) Analysis of the influence of head rotation during drug-induced sleep endoscopy in obstructive sleep apnea. Laryngoscope. doi:10.1002/lary.24598
  12. Richard W, Kox D, den Herder C et al (2006) The role of sleep position in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 263:946–950. doi:10.1007/s00405-006-0090-2
  13. American Academy of Sleep Medicine (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specification, 1st edn. Westchester, IL, USA
  14. George J, Chung S, Nielsen I (2012) Comparison of drug-induced sleep endoscopy and lateral cephalometry in obstructive sleep apnea. Laryngoscope 122:2600–2605. doi:10.1002/lary.23561

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