Surgical Success in Obstructive Sleep Apnea Patients Using Preoperative Drug‐Induced Sleep Endoscopy and Awake Endoscopy Considering Disease Severity

ABSTRACT Background Obstructive sleep apnea (OSA) is a prevalent disorder characterized by recurrent episodes of airway obstruction during sleep, leading to fragmented sleep and oxygen desaturation. Identifying the precise site and pattern of obstruction is essential for surgical success. Awake endoscopy with Müller's maneuver (AEMM) has long been used, but drug‐induced sleep endoscopy (DISE) offers dynamic assessment under sleep‐like conditions. Objective To retrospectively compare surgical outcomes of OSA patients evaluated with DISE versus AEMM, stratified by disease severity, and to determine whether the comparative value of DISE over AEMM differs according to OSA severity as measured by AEMM (AHI). Methods Records of 102 OSA patients undergoing sleep surgery between January 2022 and December 2024 at Hamad Medical Corporation were reviewed. Patients were grouped into AEMM‐only ( n = 54) and DISE ( n = 48). Surgical success was defined as postoperative AHI < 15 events/hour and at least 50% reduction from baseline. Statistical analysis included independent and paired t ‐tests, chi‐square tests, and the Johnson–Neyman procedure to identify AHI‐based thresholds of DISE benefit. Results DISE group had higher surgical success compared to AEMM (62.5% vs. 40.7%, p = 0.114). Preoperative and postoperative AHI changes were significant in both groups ( p < 0.001). Stratification revealed that moderate‐to‐severe OSA patients (AHI > 16.7) had significantly better outcomes when surgery was based on DISE ( p < 0.001). In patients with mild OSA (AHI < 16.7), DISE conferred no additional benefit over AEMM. Conclusion DISE‐based surgical planning improves outcomes in moderate‐to‐severe OSA, while AEMM remains adequate for mild OSA cases. Disease severity should guide the choice of preoperative airway assessment method.