DISE vs Muller's Maneuver in OSA Assessment

Obstructive sleep apnea (OSA) is one of the most common sleep-related breathing disorders and is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, leading to intermittent hypoxia, sleep fragmentation, and significant cardiovascular and metabolic consequences. Accurate localization of the site and pattern of upper airway collapse is essential for selecting the most appropriate treatment strategy.

Müller's maneuver is a commonly used office-based endoscopic technique that evaluates upper airway collapse during forced inspiratory effort while the patient is awake. However, its diagnostic accuracy has been questioned because it does not replicate the physiological conditions of natural sleep. Drug-Induced Sleep Endoscopy (DISE) is a dynamic endoscopic examination performed under sedation, allowing direct visualization of the upper airway during a sleep-like state and providing detailed information regarding the level, degree, and configuration of airway collapse.

The present prospective study aims to compare the findings of Drug-Induced Sleep Endoscopy with those obtained by Müller's maneuver in patients diagnosed with obstructive sleep apnea. The study will evaluate the agreement between both techniques in identifying the site and pattern of upper airway obstruction and assess the potential additional diagnostic value of DISE in the preoperative assessment and treatment planning of patients with OSA. The findings of this study may help optimize patient selection for individualized therapeutic interventions and improve clinical decision-making in the management of obstructive sleep apnea.

Inclusion criteria

• Age > 18 years old.
• Diagnosed as OSAS according to polysomnography and AASM (June 2023).
• Body mass index < 40

Exclusion criteria

• Age < 18 years.
• Central sleep apnea.
• Hypoventilation syndromes.
• Cardiac arrhythmias.
• ischemic heart disease.
• Heart failure.