Systematic Review of Drug-Induced Sleep Endoscopy Scoring Systems

Janine Amos, Megan L. Durr, Heather C. Nardone, Cristina M. Baldassari, Angela Duggins, Stacey L. Ishman

Research output: Contribution to journalReview articlepeer-review


Objective: To systematically review the scoring systems used to report findings during drug-induced sleep endoscopy (DISE) for adults and children with obstructive sleep apnea. Data Sources: PubMed, CINAHL, EBM Reviews, Embase, and Scopus databases. Review Methods: This is a systematic review of all indexed years of publications referring to scoring of DISE for children and adults with obstructive sleep apnea. The type of DISE scoring system utilized was the primary outcome. PRISMA guidelines were followed to carry out this review; articles were independently reviewed by 2 investigators. All pediatric and adult studies that utilized ≥1 DISE grading systems were included. Results: Of 492 identified abstracts, 44 articles (combined population, N = 5784) were ultimately included; 6 reported on children, 35 on adults, and 1 on children and adults. Twenty-one reporting methods were used in these studies, with the most common being the VOTE system (velum, oropharynx, tongue base, and epiglottis; 38.6%) and the Pringle and Croft classification (15.9%). The sites of obstruction most commonly included in a scoring system were the tongue base (62%), lateral pharynx/oropharynx (57%), palate (57%), epiglottis/supraglottis (38%), and hypopharynx (38%). Less commonly included sites were the larynx (29%), velum (23%), nose (23%), tongue (14%), adenoids (10%), and nasopharynx (10%). Conclusion: There is no consensus regarding which scoring system should be utilized to report findings during DISE. The VOTE system and the Pringle and Croft classification were the most frequent scoring systems reported for patients undergoing DISE. Standardization of the reporting of DISE findings would improve comparability among studies.

Original languageEnglish (US)
Pages (from-to)240-248
Number of pages9
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number2
StatePublished - Feb 1 2018
Externally publishedYes


  • DISE
  • drug-induced sleep endoscopy
  • obstructive sleep apnea
  • scoring
  • site of obstruction

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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