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.

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.

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 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 presurgical 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. 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).


sleep diagram 2regions - Drug-Induced Sleep Endoscopy

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:




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.


Pain control

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


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.

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: