Awake flexible endoscopy in supine position versus drug-induced sleep endoscopy: impact on surgical decision-making in obstructive sleep apnea: experience from a tertiary care centre in Pune, India

Seemab Shaikh; Nilesh Madkikar; Shailesh Pandey; Sukhvinder Bindra

doi:10.18203/issn.2454-5929.ijohns20260789

Authors

Seemab Shaikh Department of ENT, Inamdar Multispecialty Hospital, Senior Consultant KEM Hospital and Sahyadri Group of Hospitals, Pune, India https://orcid.org/0009-0009-3338-7938
Nilesh Madkikar Department of ENT Surgery, Inamdar multispeciality Hospitals, Tamil Nadu, India
Shailesh Pandey Department of ENT Surgery, Prime ENT Clinic and Criticare Multi-specialty Hospital, Aum ENT Clinic Andheri West Mumbai, India
Sukhvinder Bindra Apollo Hospital, Shenoy Hospitals, Somnio - The Sleep Clinic, Hyderabad, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20260789

Keywords:

Airway obstruction, Drug induced sleep endoscopy, Flexible nasopharyngolaryngoscopy, Obstructive sleep apnoea, Polysomnography, Surgical planning

Abstract

Background: Obstructive sleep apnoea (OSA), increasingly prevalent in India due to rising obesity and urbanisation, demands precise preoperative assessment for effective surgical management. This study compares awake flexible nasopharyngolaryngoscopy (FNPLS) and drug-induced sleep endoscopy (DISE) to evaluate their diagnostic contributions and impact on surgical decision-making in a resource-constrained setting.

Methods: A retrospective study at Inamdar Hospital included 177 patients (aged 18–65 years) with OSA (apnoea–hypopnoea index (AHI)>5) diagnosed via Level 2 or 3 polysomnography from January 2019 to July 2025. All underwent FNPLS and DISE to identify airway collapse sites. The study assessed whether DISE provided additional diagnostic information beyond FNPLS and influenced surgical planning. Data were analyzed using SPSS version 26 (p<0.05 for significance).

Results: All patients (100%) showed velar and oropharyngeal collapse on FNPLS and DISE. DISE revealed additional sites in 24.3% of cases, mainly tongue base (16.4%) and epiglottic collapse (2.2%), altering the primary diagnosis in 26.0% of patients. Surgical plans remained unchanged in 81.4% of cases. Mean AHI decreased significantly from 17.74±9.25 preoperatively to 9.37±5.91 post-surgery (p=0.001). No complications occurred during DISE or surgery.

Conclusions: FNPLS serves as an effective primary tool for OSA surgical planning. DISE offers valuable insights into dynamic airway collapse, enhancing diagnostic precision in select cases. Its role as a complementary investigation supports tailored surgical strategies while optimizing resource allocation.

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Author Biographies

Seemab Shaikh, Department of ENT, Inamdar Multispecialty Hospital, Senior Consultant KEM Hospital and Sahyadri Group of Hospitals, Pune, India

Senior Consultant ENT Surgeon, HOD, ENT Dept, Inamdar Multispecialty Hospital,Consultant ENT Surgeon, KEM Hospital, Pune, Consultant ENT Surgeon, Sahyadri Group of Hospitals, Pune, India

Nilesh Madkikar, Department of ENT Surgery, Inamdar multispeciality Hospitals, Tamil Nadu, India

Consultant ENT Surgeon, Inamdar Multi-specialty Hospital Pune, Consultant ENT Surgeon Center for Advanced ENT and Facial Aesthetic, Director Sulmersense India Sleep Center Pune, Visiting faculty, Kavery Multi-specialty Hospital Chennai, India.

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