Drug-Induced Sleep Endoscopy
A short, sedated procedure that shows your surgeon exactly where and how your airway collapses during sleep — so treatment can be tailored to your anatomy.
What Is DISE?
Drug-induced sleep endoscopy (DISE) is a brief diagnostic procedure performed under light sedation. While you sleep, your surgeon passes a thin, flexible camera through your nose to observe your upper airway in real time. The goal is to identify the specific sites and patterns of collapse that are causing your obstruction — information that an office exam alone often cannot reveal.
Think of it this way: a standard office evaluation looks at your airway while you’re awake and sitting upright. DISE lets your surgeon see what actually happens when you’re asleep and your muscles relax — the same conditions that produce obstructive sleep apnea.
Why Is DISE Performed?
DISE provides information that changes the surgical plan in roughly half of all patients evaluated.
See What’s Really Happening
Awake exams can underestimate the degree of collapse — particularly at the tongue base and epiglottis. DISE reveals obstruction patterns that may be completely invisible during an office visit.
Guide Surgical Planning
Research shows that DISE changes the recommended procedure in about 50% of patients. Knowing exactly where your airway collapses helps your surgeon select the right operation — and avoid unnecessary ones.
Evaluate Implant Candidacy
For patients considering hypoglossal nerve stimulation (Inspire or Genio), DISE can identify specific collapse patterns — like complete concentric collapse — that affect which device may be right for you.
How DISE Works
The procedure is brief, safe, and typically takes about 15–20 minutes.
Light Sedation
You receive a sedative (typically propofol) through an IV, bringing you to a state that closely mimics natural sleep. You are not fully under general anesthesia — the goal is to reproduce the muscle relaxation that causes your airway to collapse during sleep.
Endoscopic Evaluation
Once you’re sedated, your surgeon passes a thin, flexible camera through your nose and into the back of your throat. The camera provides a real-time, high-definition view of your entire upper airway — from the soft palate down to the voice box.
Systematic Assessment
Your surgeon evaluates each level of the airway using a standardized scoring system (called the VOTE classification), looking at the velum (soft palate), oropharynx (throat walls), tongue base, and epiglottis. At each level, the degree and direction of collapse are recorded.
Recovery
You wake up within minutes and can typically go home within an hour. Most patients don’t remember the procedure and experience no discomfort. The results are reviewed with you at a follow-up visit to discuss your treatment options.
What DISE Reveals
Every patient’s airway is different. DISE identifies specific patterns of collapse that help determine the best treatment approach.
Palatal Collapse
The soft palate is the most common site of obstruction. DISE shows whether collapse is front-to-back, side-to-side, or concentric (all directions). The pattern influences which palatal procedure — if any — is most appropriate.
Lateral Wall Collapse
The side walls of the throat can narrow or close during sleep. Lateral wall collapse is one of the more challenging patterns to treat surgically, and identifying it early helps set realistic expectations and select the best approach.
Tongue Base Collapse
The base of the tongue can fall backward and block the airway during sleep. This is a common finding on DISE that is frequently underestimated — or missed entirely — on an awake office exam. It is a key factor in determining candidacy for hypoglossal nerve stimulation.
Epiglottic Collapse
The epiglottis — the small flap of cartilage that covers your windpipe when you swallow — can fold over the airway during sleep. This type of collapse is nearly impossible to detect during an office exam and is one of the most important reasons to perform DISE.
DISE and Hypoglossal Nerve Stimulation
If you’re considering an implant for sleep apnea, DISE plays an important role in determining which device may be the best fit.
DISE Is Required
Inspire requires a DISE evaluation before implantation. The key finding your surgeon is looking for is complete concentric collapse (CCC) at the level of the soft palate — a pattern where the palate closes in from all directions. Patients with CCC are not candidates for Inspire.
DISE also helps confirm that the tongue base is a meaningful contributor to your obstruction, which is important because Inspire works by stimulating one side of the hypoglossal nerve to move the tongue forward and open the airway.
DISE Is Required
Like Inspire, Genio requires a DISE evaluation before implantation. Genio received FDA approval for patients regardless of whether they have complete concentric collapse — though current U.S. labeling covers non-CCC patients only. DISE confirms your specific collapse pattern and helps your surgeon verify that bilateral hypoglossal nerve stimulation is the right approach for your anatomy.
Because Genio stimulates both sides of the hypoglossal nerve, understanding the full airway picture — including the tongue base and lateral walls — is essential for predicting how you will respond to therapy.
What to Expect
Here’s what a typical DISE experience looks like from start to finish.
Before the Procedure
DISE is performed in an operating room or procedure suite, usually as a standalone outpatient procedure or immediately before a planned sleep surgery. You will be asked not to eat or drink for several hours beforehand. An IV is placed, and standard monitors (heart rate, oxygen level) are applied.
During the Procedure
You will receive sedation through your IV. Within a few minutes, you’ll drift into a sleep-like state. Your surgeon will pass a small camera through your nose — there is no incision and nothing is placed through your mouth. The evaluation itself typically takes 15–20 minutes. Your oxygen level and vital signs are monitored continuously throughout.
After the Procedure
You’ll wake up quickly once the sedation is stopped — most patients are alert within a few minutes. You may have mild nasal irritation that resolves within hours. You can typically go home within an hour and resume normal activities the same day. Because of the sedation, you will need someone to drive you home.
Getting Your Results
Your surgeon will review the DISE findings with you and explain how they factor into your treatment plan. If you are being evaluated for a hypoglossal nerve stimulator, the DISE results help determine which device — if either — is the best fit for your anatomy.
Common Questions
Is DISE painful?
No. You are sedated during the entire procedure and will not feel discomfort. Most patients don’t remember it at all. Some experience very mild nasal irritation afterward that resolves quickly.
Is DISE safe?
Yes. DISE is a well-established, low-risk diagnostic procedure. You are monitored continuously by an anesthesia provider throughout. Serious complications are extremely rare.
Does everyone with sleep apnea need DISE?
Not necessarily. DISE is most commonly performed for patients being evaluated for sleep surgery or a hypoglossal nerve stimulator. Your surgeon will let you know whether it is recommended or required based on your individual situation and the treatment options being considered.
Can DISE be done at the same time as my surgery?
It depends on your insurance. Some plans allow DISE to be performed immediately before a planned procedure while you are already under anesthesia, which can reduce the number of trips to the operating room. Others require it as a separate visit. Your surgeon’s office will verify coverage and let you know what to expect.
What if my DISE shows I’m not a candidate for an implant?
DISE findings are one piece of the puzzle. If a specific collapse pattern makes one device less suitable, other surgical options may still be available. Your surgeon will work with you to find the best path forward based on the full picture.
Is DISE covered by insurance?
DISE is generally covered by insurance when performed as part of a surgical evaluation for obstructive sleep apnea. Our office will verify coverage and obtain any required authorization before scheduling your procedure.
Learn Which Treatment Fits Your Anatomy
DISE is one step in finding the right approach to treating your sleep apnea. Explore the tools on this site to compare your options and prepare for your consultation.
See What DISE Reveals
Each video shows a different airway collapse pattern captured during drug-induced sleep endoscopy.