This article looks at the wide variety of classification systems currently available for interpreting drug induced sleep endoscopy (DISE).The fact that there are so many classification systems, suggests that there is: A) a lot of disagreement about how DISE should be interpreted; and B) none of them are particularly good. Classification systems should be on the one hand simple and reliable but also accurate enough to describe the information displayed. One of the problems of DISE is that we are trying to describe a hideously complex dynamic event which is in constant movement. So, keeping it simple whilst also trying to describe complexity is a challenge in itself. To make matters worse, we are still unsure what elements are important in what we are looking at, and the technique itself is not standardised, and so many people have variable and depressing results. Trying to develop a classification system based on this situation is almost certainly doomed to failure. What is clear from this paper is that there are a number of common threads in the various classification systems, and that gives me some hope that things are slowly being consolidated in to a unified system. The European sleep surgeons are due to meet again to try and again reach a consensus on all matters DISE. Personally, I think that without a common language that is validated for use, we aren’t going to get very far in this speciality.

Drug-induced sedation endoscopy (DISE) classification systems: a systematic review and meta-analysis.
Dijemeni E, D’Amone G, Gbati I.
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Vik Veer

Royal National Throat, Nose & Ear Hospital and Queens Hospital, Romford, UK.

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