الفهرس 
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Abstract
This study was done to evaluate the reliability of DISE in identifying the level of obstruction in SDB patients compared to the results obtained from the classic ENT evaluation techniques in order to improve the diagnosis and treatment options for patients with SDB. It was done on 66 patients (34 males and 32 females) with ages ranging from 23 to 58 years old; suffering from OSAS diagnosed by polysomnography and patients suffering from habitual snoring.
All patients were submitted for history taking in which daytime sleepiness according to the ESS was recorded and full ENT examination including anterior rhinoscopy and oropharyngeal examination including the use of modified Malampatti index, inspection of the size of the uvula, size and dorsalization of the tongue and tonsil size (according to Friedman staging system). Assessment of the BMI and the NC at the level of the cricothyroid membrane. MM and DISE was then performed to all patients in the theater with an ENT specialist using the NOHL classification system for DISE.
BMI calculations showed that 86.4 % of cases were obese with mean BMI (35.1 ± 5.6) ranging from (24 - 50 kg/m2). NC measurement showed large NC (> 37cm) in 100 % of females while it was large (> 43 cm) in only 29.4 % of males. The mean apnea hypopnea index was 10.7 ± 11.8/h.
We found a great difference that was highly statistically significant when we made a comparison between the results of the MMI used in the classic ENT evaluation techniques and those of DISE as we found that at grade 3 and 4 by MMI we will notice that 6 patients showed 25-50% obstruction by DISE so DISE showed us that they were in no need for UPPP. We can notice another important relation at grade 2 MMI where 7 patients out of 10 shown by DISE will need surgical interference as they suffered from obstruction 50-100%.
In the assessment of the degree of nasal obstruction the results of MM and DISE were the same regarding D.S or HITs, both showed that 51 patients (77.3 %) had obstruction ranging from (0- 25 %) due to D.S in 28 patients and HITs in 23 patients and 15 patients (22.7 %) had a degree of obstruction ranging from 25 – 50 % due to D.S in 12 patients and HITs in 3 patients.
We found that most of the patients had obstruction at the oropharyngeal level, 82% (n=54/66) of the patients showed from (50-100%) obstruction at the level of the oropharynx and the second most commonly noted obstruction level at high grades of obstruction in our patient group was the hypopharynx in 68% (n=45/66). Only 13.6% (n=9/66) of our patients showed supraglottic obstruction due to flappy epiglottis and no glottic obstruction.
Almost all patients showed multilevel obstruction with different grades. We found no correlation between the results of DISE and those of MM and classic ENT evaluation techniques and the difference was statistically significant. DISE treatment recommendations were different in 82% of patients at the oropharyngeal level and in 39% at the hypopharyngeal level than those of MM, but were nearly the same regarding supraglottic and glottic obstruction.