Awake flexible endoscopy in supine position versus drug-induced sleep endoscopy: impact on surgical decision-making in obstructive sleep apnea: experience from a tertiary care centre in Pune, India

Background: Obstructive sleep apnoea (OSA), increasingly prevalent in India due to rising obesity and urbanisation, demands precise preoperative assessment for effective surgical management. This study compares awake flexible nasopharyngolaryngoscopy (FNPLS) and drug-induced sleep endoscopy (DISE) to evaluate their diagnostic contributions and impact on surgical decision-making in a resource-constrained setting. Methods: A retrospective study at Inamdar Hospital included 177 patients (aged 18–65 years) with OSA (apnoea–hypopnoea index (AHI)>5) diagnosed via Level 2 or 3 polysomnography from January 2019 to July 2025. All underwent FNPLS and DISE to identify airway collapse sites. The study assessed whether DISE provided additional diagnostic information beyond FNPLS and influenced surgical planning. Data were analyzed using SPSS version 26 (p<0.05 for significance). Results: All patients (100%) showed velar and oropharyngeal collapse on FNPLS and DISE. DISE revealed additional sites in 24.3% of cases, mainly tongue base (16.4%) and epiglottic collapse (2.2%), altering the primary diagnosis in 26.0% of patients. Surgical plans remained unchanged in 81.4% of cases. Mean AHI decreased significantly from 17.74±9.25 preoperatively to 9.37±5.91 post-surgery (p=0.001). No complications occurred during DISE or surgery. Conclusions: FNPLS serves as an effective primary tool for OSA surgical planning. DISE offers valuable insights into dynamic airway collapse, enhancing diagnostic precision in select cases. Its role as a complementary investigation supports tailored surgical strategies while optimizing resource allocation.