European position paper on drug induced sedation endoscopy (DISE)
Reviewed by Vik Veer

DISE is a controversial topic but a practice that is largely accepted in the UK. There has been much variation about the technique, and how to interpret the results. For this reason, a collection of European DISE bigwigs aimed for consensus of opinion with a position paper. In summary this group decided that standard practice for DISE should include: avoidance of local anaesthesia, or decongestants or indeed any drugs at all that may influence the examination of the upper airway; assess supine, with and without gentle jaw thrust to simulate a mandibular advancement splint; sedation may be induced by propofol, midazolam or a combination. The advantages and disadvantages, and differing infusion techniques of each are appraised in the paper. Although not implicitly stated, a combination of the two seems to be favoured; and depending on the drugs used for sedation, two or more cycles of airway collapse need to be allowed before beginning the examination. The major stumbling block was on how to describe what is found. Seven common classification systems were examined, and no consensus was found indicating that they are probably all flawed. There is a long way to go before we have a standardised DISE technique, and this is mainly because of lack of research in the field. The exponential growth in DISE related research in recent years should help this European group reach a more satisfactory conclusion next time they meet.

European position paper on drug-induced sedation endoscopy (DISE).
De Vito A, Carrasco Llatas M, Vanni A, et al.
SLEEP AND BREATHING
2014;18(3):453-65.