Researchers from Penn Medicine have developed a safe and effective technique for inducing sleep in patients with severe obstructive sleep apnea. The new procedure, known as drug-induced sleep endoscopy (DISE), uses progressive doses of anesthesia to pharmacologically induce sleep to the point of the obstruction-causing apnea in a short time frame without a dip in blood oxygen level and with few side effects.

The Penn team recently tested the procedure in 97 patients with severe sleep apnea who were candidates for transoral robotic resection of the tongue, the removal of a section the tongue where it meets the epiglottis to prevent the tongue from obstructing the airway during sleep, the most common surgical procedure for the treatment of severe sleep apnea. Study results are reported in Anesthesia and Analgesia.

TransOral Robotic Surgery (TORS) was originally developed by Penn head and neck surgeons for the removal of benign and malignant tumors of the mouth and throat.

“The Continuous Positive Airway Pressure (CPAP) mask does not provide relief for every patient with severe sleep apnea and daily compliance can also be difficult for some patients,” says Joshua Atkins, MD, PhD, lead author on the study and director of Anesthesia for Head and Neck Surgery. “In order to evaluate patients for surgery, we need to visualize the obstruction, often quickly and in an office visit, outside of the sleep lab.” 

DISE allows physicians to recreate the obstruction in that environment. The new procedure helps pinpoint the proper doses and timing of propofol – a short-acting drug commonly used to induce the anesthetic state– to safely and quickly bring patient’s to the point during their sleep that this problem would occur.

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