DISE vs Muller's Maneuver in OSA Assessment

Role of Drug-Induced Sleep Endoscopy in Comparison to Muller's Maneuver in Obstructive Sleep Apnea Syndrome Assessment

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder caused by recurrent upper airway collapse during sleep. Accurate identification of the site and pattern of upper airway obstruction is essential for selecting the appropriate treatment. Müller's maneuver has been widely used as an office-based assessment tool; however, it has limitations in reproducing natural sleep conditions. Drug-Induced Sleep Endoscopy (DISE) allows dynamic visualization of the upper airway under sedated conditions and may provide more accurate information about the level and pattern of airway collapse. This study aims to compare the findings of DISE with Müller's maneuver in patients with obstructive sleep apnea and to evaluate the diagnostic value of both techniques in upper airway assessment.

Study Overview

• Status: Completed
• Conditions: Obstructive Sleep Apnea
• Intervention / Treatment: Procedure: Drug-Induced Sleep Endoscopy (DISE)

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Dakahlia Governorate
    • Al Mansurah, Dakahlia Governorate, Egypt, 35511
      • Mansoua University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

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

Exclusion Criteria:

1. Age < 18 years.
2. Central sleep apnea.
3. Hypoventilation syndromes.
4. Cardiac arrhythmias.
5. ischemic heart disease.
6. Heart failure.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Single Study Arm; Participants with obstructive sleep apnea will undergo awake flexible endoscopy with Müller's maneuver followed by Drug-Induced Sleep Endoscopy (DISE). The findings of both procedures will be compared to assess the site, degree, and pattern of upper airway obstruction.	Procedure: Drug-Induced Sleep Endoscopy (DISE); Drug-induced sleep endoscopy performed under sedation to evaluate the site, degree, and pattern of upper airway collapse in patients with obstructive sleep apnea.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Agreement between Drug-Induced Sleep Endoscopy (DISE) using the VOTE cassification and Müller's Maneuver in assesment of OSA.	Agreement between Drug-Induced Sleep Endoscopy (DISE) findings, assessed using the VOTE classification, and Müller's maneuver findings in identifying the site, degree, and pattern of upper airway collapse in patients with obstructive sleep apnea. Agreement will be quantified using Cohen's kappa coefficient.	Baseline (during the same study visit)

Collaborators and Investigators

• Sponsor: Mansoura University
• Investigators: Study Chair: Lucy Soliman, Professor, Chest Medicine Department, Faculty of Medicine, Mansoura University

Study record dates

Study Major Dates

• Study Start (Actual): February 12, 2025
• Primary Completion (Actual): September 10, 2025
• Study Completion (Actual): March 15, 2026

Study Registration Dates

• First Submitted: July 17, 2026
• First Submitted That Met QC Criteria: July 22, 2026
• First Posted (Actual): July 23, 2026

Study Record Updates

• Last Update Posted (Actual): July 23, 2026
• Last Update Submitted That Met QC Criteria: July 22, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Respiratory Tract Diseases; Respiration Disorders; Sleep Wake Disorders; Apnea; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
• Other Study ID Numbers: MS.24.12.3032

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No