Dr. Kezirian is considered one of the world’s experts in drug-induced sleep endoscopy and its role in the selection of procedures and improving results of surgery.

Safe Drug-Induced Sleep Endoscopy for Sleep Apnea

Successful surgical treatment of obstructive sleep apnea is based on the accurate identification of the pattern of airway obstruction and targeted, effective treatment. In the throat, there are two major areas that can be responsible: the palate and tongue regions. For many years, the primary surgical treatment for obstructive sleep apnea was soft palate surgery, and this worked well for patients with blockage of breathing in the palate region alone. Unfortunately, many patients also appear to have blockage of breathing in the tongue region, and multiple procedures have been developed to address this in the hope of improving surgical outcomes. On his blog, Dr. Kezirian has written about his drug-induced sleep endoscopy technique.

What is drug-induced sleep endoscopy?

During drug-induced sleep endoscopy, patients receive sedation administered by an anesthesiologist in the operating room. As patients begin to snore and have some blockage of their breathing, Dr. Kezirian passes a flexible telescope through one side of the nose in order to evaluate the throat and observe the potential blockage of breathing in the palate and tongue regions. This technique was described almost two decades ago and is used in many centers around the world. Dr. Kezirian’s research has advanced the understanding of drug-induced sleep endoscopy, and his ongoing work seeks to determine whether it predicts outcomes from surgery. Dr. Kezirian appreciates the opportunity to train other surgeons in this technique and other aspects of sleep apnea surgery evaluation.

Why should I undergo drug-induced sleep endoscopy?

Drug-induced sleep endoscopy is performed to determine whether blockage in breathing is occuring in the Palate and/or Tongue Region(s) and, more specifically, which specific structures seem to be playing a major role in airway obstruction. This is true for patients who are considering surgery for the first time and in those who have not obtained ideal results after previous procedures. Dr. Kezirian incorporates information from other evaluation techniques to make a decision with our patients and believes that drug-induced sleep endoscopy provides additional, helpful information in certain patients.

Dr. Kezirian believes in performing research that improves the care of patients. He has led two recent studies that will be landmark studies showing how drug-induced sleep endoscopy can improve decisions about surgical treatment. Dr. Kezirian has written on his blog about drug-induced sleep endoscopy and recently-published research, including his own. He has also led major international studies showing that drug-induced sleep endoscopy is associated with surgical outcomes and can improve surgical outcomes and that drug-induced sleep endoscopy is associated with results of Inspire Upper Airway Stimulation. Dr. Kezirian is now administering CPAP during drug-induced sleep endoscopy (DISE-PAP) and has shown why some patients do not achieve success with CPAP, even with increasing CPAP pressures.

How does drug-induced sleep endoscopy differ from an in-lab sleep study?

Traditional in-lab sleep studies (polysomnography) and home sleep apnea tests serve an essential diagnostic purpose: confirming the presence of obstructive sleep apnea and measuring its severity. Polysomnography records brain waves, blood oxygen levels, heart rates, and respiratory effort during sleep, establishing that breathing disruptions are occurring. However, diagnostic sleep studies do not show where or why the airway is collapsing.

This functional limitation is where drug-induced sleep endoscopy fills the diagnostic gap. While an overnight study records overall numerical data while asleep in a lab bed, drug-induced sleep endoscopy for sleep apnea allows Dr. Kezirian to inspect the dynamic airway visually in real time. Under controlled sedation in an operating room, Dr. Kezirian passes a thin, flexible endoscope through the nasal passage to observe the causes of obstructive sleep apnea: palate, lateral pharyngeal walls, tongue, and/or epiglottis.

Combining diagnostic sleep study results with dynamic endoscopic imaging during drug-induced sleep endoscopy bridges the gap between diagnosing a sleep disorder and selecting a targeted sleep apnea surgery intervention. Dr. Kezirian believes in delivering comprehensive care that addresses both the severity of obstructive sleep apnea and the causes.

Take the next step toward targeted relief

Choosing from treatment options for snoring and obstructive sleep apnea requires experienced, specialized guidance. Dr. Kezirian is dedicated to identifying the exact anatomical causes of airway obstruction and delivering precise, individualized solutions. To learn more about diagnostic options, schedule a video or in-person consultation with Dr. Kezirian today.

Frequently asked questions

Is drug-induced sleep endoscopy painful?

No. Local anesthetic (numbing medication) is applied inside the nasal passages before the procedure. Intravenous sedation ensures patients remain comfortable and asleep throughout the evaluation. Mild nasal dryness or light throat tickling may occur briefly afterward.

How long does recovery take after the evaluation?

Physical recovery from the endoscopic examination itself is immediate. Because sedative medications are used, patients should rest for the remainder of the day and refrain from driving or operating machinery until the following morning.

Can drug-induced sleep endoscopy determine why CPAP therapy has failed?

Yes. Performing drug-induced sleep endoscopy for sleep apnea and also adminstering CPAP allows Dr. Kezirian to observe how positive airway pressure affects specific structures in the throat, identifying why air leaks or structural blockages persist despite increasing pressure settings. Dr. Kezirian has published research in one of the world’s top medical journals focused on lung issues, showing that CPAP can actually worsen the blockage of breathing in some patients with obstructive sleep apnea.

How soon after drug-induced sleep endoscopy can a recommended sleep apnea surgery be performed?

Following the procedure, Dr. Kezirian reviews the recorded video findings with patient during a follow-up consultation. Once a tailored surgical strategy is selected, scheduling for sleep apnea surgery can proceed based on patient preference and operating room availability, usually within 2-3 months.

Does drug-induced sleep endoscopy require an overnight hospital stay?

No. The procedure is performed strictly on an outpatient basis. Patients arrive, undergo the diagnostic evaluation under anesthesia, recover briefly, and return home the same day.

Here is a link to a lecture for otolaryngology – head and neck surgery residents about drug-induced sleep endoscopy in obstructive sleep apnea (it may have too much medical English, but the link is presented here because some may enjoy it).

The following video presents a discussion of the selection of surgical procedures, including drug-induced sleep endoscopy:

The following video presents a more-detailed discussion of drug-induced sleep endoscopy, including some example videos:

The following video discusses the role of drug-induced sleep endoscopy in the selection of surgical procedures and oral appliances:

RISKS

Allergic reaction

Patients who are allergic to egg products, soy, or glycerol should discuss this with your doctor. The sedative medication used in drug-induced sleep endoscopy is propofol, which contains egg lecithin, soybean oil, and glycerol, and the risk of allergy is particularly high in patients who are allergic to these.

Blockage or stoppage of breathing

Sedatives relax the muscles around the throat and can slow down breathing rates. To reduce the risk of this complication, the procedure is performed in the operating room with extensive monitoring of patients and with the involvement of the Anesthesia and Otolaryngology-Head and Neck Surgery teams. The medication is given very slowly, with the goal of giving just enough for patients to become sedated and start the process of snoring and blockage of breathing that has been shown on the sleep study without sedation. It is uncommon for too much muscle relaxation or stoppage of breathing occurs, but there are many conservative treatments that can be performed such as stopping the medication (it takes effect quickly and wears off quickly), lifting the lower jaw forward, or having one of the physicians in the operating room use a mask to help with breathing. Alternatively, if these and other measures do not resolve the problem, a breathing tube can be placed through the mouth, or a tracheotomy (breathing tube directly through the neck into the windpipe) can be performed.

POSTOPERATIVE INSTRUCTIONS

Pain control

You should have no pain after this procedure, and no pain medications will be prescribed specifically for it.

Drowsiness

Because you have received anesthesia, you should take all necessary precautions, including not driving or operating heavy machinery. Generally, all patients should not work on the same day following the procedure, although many patients feel like they have recovered fully within a couple of hours after the procedure.

Dry mouth and throat

Because you have to be without eating and drinking before surgery, you may have a dry mouth and throat. You may also receive a medication to decrease saliva production, as this can improve the ability for Dr. Kezirian to see clearly inside your throat during the drug-induced sleep endoscopy. After the procedure, you should drink plenty of liquids to address your dry mouth and throat, as these can be uncomfortable if you do not drink enough liquids.

Nose irritation (runny nose, mucus, bleeding)

Drug-induced sleep endoscopy involves placement of a telescope through the nose into the throat, typically for 5-15 minutes. Although care is taken to numb the nose and open up space for the telescope, there still can be some irritation of the nose. This can result in the production of mucus and possible bleeding (almost always just a small amount, if any). If this occurs, it can be helpful to use nasal saline spray (2 sprays in the affected nostril, 3 times a day) or Afrin spray (1-2 sprays in the nose, not more than twice a day for 2 days).

Follow up visit

Because drug-induced sleep endoscopy is performed to evaluate blockage of breathing in the throat, and generally patients will have a follow up appointment after the procedure to review the video and discuss the next steps to move forward with treatment.

To learn more about surgical treatment options, please continue to: