Striatal brain volume linked to severity of substance use in high-risk incarcerated youth.

Substance use disorders among juveniles are a major public health concern and are often intertwined with other psychosocial risk factors including antisocial behavior. Identifying etiological risks and mechanisms promoting substance use disorders remains a high priority for informing more focused interventions in high-risk populations. The present study examined brain gray matter structure in relation to substance use severity among n = 152 high-risk, incarcerated boys (aged 14-20). Substance use severity was positively associated with gray matter volume across several frontal/striatal brain regions including amygdala, pallidum, putamen, insula, and orbitofrontal cortex. Effects were apparent when using voxel-based-morphometric analysis, as well as in whole-brain, data-driven, network-based approaches (source-based morphometry). These findings support the hypothesis that elevated gray matter volume in striatal reward circuits may be an endogenous marker for vulnerability to severe substance use behaviors among youth.

Psychopathic Traits Are Associated with Lifetime History of Nicotine Dependence among Incarcerated Offenders.

Background: Individuals scoring high on psychopathy engage in problematic patterns of alcohol and illicit substance use. However, our understanding regarding the association between psychopathy and nicotine use remains limited, which is surprising, given the detrimental consequences associated with such use. Previous studies have observed significant correlations between psychopathic traits (particularly Factor 2 scores assessing lifestyle/behavioral and antisocial traits from the Psychopathy Checklist - Revised [PCL-R]) and increased frequency of nicotine use. However, no study has investigated whether individuals scoring high on psychopathy are characterized by problematic patterns of nicotine use, including lifetime history of nicotine dependence.Objectives: The current study aimed to address this gap, specifically investigating whether PCL-R scores were associated with higher total scores from the Fagerström Test for Nicotine Dependence (FTND).Results: Across both incarcerated men and women, PCL-R total, Factor 2, and Facet 3 (measuring lifestyle/behavioral psychopathic traits) scores were positively correlated with FTND total scores. Additionally, across both samples, hierarchical linear regression analyses revealed these same psychopathy scores remained associated with higher FTND total scores when controlling for additional covariate measures (e.g., age, severity of alcohol and illicit substance use, race, ethnicity, and IQ).Conclusions/Importance: Though associated with small effect sizes, our results support the notion that lifestyle/behavioral psychopathic traits represent a general risk factor for engaging in risky behavior associated with deleterious health consequences, including nicotine use. Our results hold implications for the development of treatment approaches, designed to reduce problematic levels of substance use among individuals scoring high on psychopathy.

Automated patterns of head dynamics are associated with psychopathic traits in incarcerated women.

Men with elevated psychopathic traits have been characterized by unique patterns of nonverbal communication, including more fixed and focused head positions during clinical interviews, compared to men scoring low on measures of psychopathy. However, it is unclear whether similar patterns of head dynamics help characterize women scoring high on psychopathic traits. Here, we utilized an automated detection algorithm to assess head position and dynamics during a videotaped clinical interview (i.e., the Psychopathy Checklist - Revised [PCL-R]) in a sample of n = 213 incarcerated women. PCL-R Total, Factor 1 (i.e., interpersonal and affective psychopathic traits), and Factor 2 (i.e., lifestyle/behavioral and antisocial/developmental psychopathic traits) scores were associated with a pattern of head dynamics indicative of a rigid head position. The current study extends analyses of nonverbal behavior studies in men to women and highlights how individuals with elevated psychopathic traits demonstrate unique nonverbal behaviors relative to individuals who score low on psychopathic traits. The implications and clinical value of these findings are discussed.

The clinical landscape of cell-free DNA alterations in 1671 patients with advanced biliary tract cancer.

BACKGROUND: Targeted therapies have transformed clinical management of advanced biliary tract cancer (BTC). Cell-free DNA (cfDNA) analysis is an attractive approach for cancer genomic profiling that overcomes many limitations of traditional tissue-based analysis. We examined cfDNA as a tool to inform clinical management of patients with advanced BTC and generate novel insights into BTC tumor biology. PATIENTS AND METHODS: We analyzed next-generation sequencing data of 2068 cfDNA samples from 1671 patients with advanced BTC generated with Guardant360. We carried out clinical annotation on a multi-institutional subset (n = 225) to assess intra-patient cfDNA-tumor concordance and the association of cfDNA variant allele fraction (VAF) with clinical outcomes. RESULTS: Genetic alterations were detected in cfDNA in 84% of patients, with targetable alterations detected in 44% of patients. Fibroblast growth factor receptor 2 (FGFR2) fusions, isocitrate dehydrogenase 1 (IDH1) mutations, and BRAF V600E were clonal in the majority of cases, affirming these targetable alterations as early driver events in BTC. Concordance between cfDNA and tissue for mutation detection was high for IDH1 mutations (87%) and BRAF V600E (100%), and low for FGFR2 fusions (18%). cfDNA analysis uncovered novel putative mechanisms of resistance to targeted therapies, including mutation of the cysteine residue (FGFR2 C492F) to which covalent FGFR inhibitors bind. High pre-treatment cfDNA VAF was associated with poor prognosis and shorter response to chemotherapy and targeted therapy. Finally, we report the frequency of promising targets in advanced BTC currently under investigation in other advanced solid tumors, including KRAS G12C (1.0%), KRAS G12D (5.1%), PIK3CA mutations (6.8%), and ERBB2 amplifications (4.9%). CONCLUSIONS: These findings from the largest and most comprehensive study to date of cfDNA from patients with advanced BTC highlight the utility of cfDNA analysis in current management of this disease. Characterization of oncogenic drivers and mechanisms of therapeutic resistance in this study will inform drug development efforts to reduce mortality for patients with BTC.

PSYCHOPATHY AND RISKY SEXUAL BEHAVIOR IN INCARCERATED WOMEN.

To date, very few studies have explored the association between psychopathic traits and risky sexual behavior (RSB) among women. Here, we investigated this relationship in a sample of 137 incarcerated women. Psychopathic traits were assessed via the Hare Psychopathy Checklist-Revised (PCL-R) and lifetime RSB measures, including number of lifetime sexual partners, frequency of engaging in sexual intercourse while intoxicated, and frequency of forgoing protection (e.g., condom usage) during sexual intercourse, were assessed through self-report. PCL-R Facet 3 scores (assessing lifestyle psychopathic traits) were associated with an increased frequency of engaging in sexual intercourse while intoxicated. In addition, women scoring high on the PCL-R were more likely to engage in sexual intercourse while intoxicated compared with a previously collected sample of men scoring high on the PCL-R. The results obtained in the current study help improve our understanding of the association between psychopathic traits and RSB among women.

Standardized framework to report on the role of sleeping position in sleep apnea patients.

PURPOSE: Sleep apnea is a multifactorial illness which can be differentiated in various physiological phenotypes as a result of both anatomical and non-anatomical contributors (e.g., low respiratory arousal threshold, high loop gain). In addition, the frequency and duration of apneas, in the majority of patients with OSA, are influenced by sleeping position. Differences in characteristics between non-positional patients (NPP) and positional patients (PP) suggest another crucial phenotype distinction, a clinical phenotype focusing on the role of sleeping position on sleep apnea. Since this clinical phenotype distinction has therapeutic implications, further research is necessary to better understand the pathophysiology behind this phenotypic trait and to improve management of PP. Therefore, we suggest a standardized framework that emphasizes the role of sleeping position when reporting clinical and research data on sleep apnea. METHODS: We identified 5 key topics whereby a standardized framework to report on the role of sleeping position would be of added value: (1) sleep study data, (2) anatomical, morphological and physiological factors, (3) drug-induced sleep endoscopy (DISE) findings, (4) sleep apnea management, and (5) effectiveness versus efficacy of positional therapy in sleep apnea management. We performed a literature search to identify evidence to describe and support the rationale behind these 5 main recommendations. RESULTS: In this paper, we present the rationale behind this construct and present specific recommendations such as reporting sleep study indices (disease severity) and sleep time spent in various sleeping positions. The same is suggested for DISE findings and effect of treatment. Sleep study indices (disease severity), anatomical, morphological, and physiological factors in sleep apnea patients should be reported separately for PP and NPP. CONCLUSION: Applying these suggestions in future research will improve patient care, assist in better understanding of this dominant phenotype, and will enhance accurate comparisons across studies and future investigations.

Diagnosis and treatment of isolated snoring-open questions and areas for future research.

STUDY OBJECTIVES: Snoring is a common phenomenon which is generated by vibration of soft tissue of the upper airway during sleep. Due to the high incidence of isolated snoring and the substantial burden for the patient and the bed partner, a thorough examination and appropriate therapy are required. Many recommendations for the treatment of isolated snoring are either not evidence-based or are derived from recommendations for the management of obstructive sleep apnea. Therefore, the aim of this study is the identification and description of open questions in the diagnosis and treatment of isolated snoring and the illustration of areas for further research. METHODS: In the context of the development of the new version of the German guideline "Diagnosis and treatment of isolated snoring in adults," a multidisciplinary team of experts performed a systematic literature search on the relevant medical data and rated the current evidence regarding the key diagnostic and therapeutic measures for snoring. RESULTS: The systematic literature review identified 2293 articles. As a major inclusion criterion, only studies on primary snoring based on objective sleep medical assessment were selected. After screening and evaluation, 33 full-text articles remained for further analysis. Based on these articles, open questions and areas for future research were identified for this review. CONCLUSION: Several major gaps in the literature on the diagnosis and treatment of isolated snoring were identified. For the majority of diagnostic and therapeutic measures for snoring, high-level scientific evidence is still lacking.

Reduced endorsement of specific moral foundations in incarcerated adult women with elevated psychopathic traits.

Previous studies have associated adult men with elevated psychopathic traits with reduced endorsement of certain moral foundations measured with the Moral Foundations Questionnaire (MFQ), including Harm/Care (measuring one's concern for protecting individuals from harm) and Fairness/Reciprocity (measuring one's concern for the rights of individuals). However, it is not known whether such results extrapolate to women with elevated levels of psychopathic traits. Here, we examined the relationship between endorsement of moral foundations (assessed via the MFQ) and psychopathy scores (assessed via the Psychopathy Checklist - Revised [PCL-R]) in a sample of 299 incarcerated adult women. Consistent with hypotheses, higher PCL-R total scores were associated with reduced endorsement of MFQ Harm/Care and Fairness/Reciprocity foundations. Additionally, we extended upon previous studies, observing higher PCL-R total, Factor 1 (measuring interpersonal/affective psychopathic traits), and Facet 1 (measuring interpersonal psychopathic traits) scores were associated with reduced endorsement of the MFQ Authority/Respect foundation (measuring one's respect for authority figures) in incarcerated adult women. Our results highlight reduced endorsement for similar moral foundations between men and women scoring high on psychopathic traits (i.e., Harm/Care and Fairness/Reciprocity), while also outlining a moral foundation that may be uniquely associated with women scoring high on psychopathic traits (i.e., Authority/Respect).

PSYCHOPATHY, BORDERLINE PERSONALITY DISORDER, AND SUBSTANCE USE IN INCARCERATED FEMALES.

Psychopathy and borderline personality disorder (BPD) are commonly associated with an increased propensity toward substance use. However, few studies have accounted for shared variance between psychopathy and BPD when examining relationships with unique forms of substance use, particularly in justice-involved females. This study investigated psychopathic and BPD traits in relation to alcohol and drug use in a sample of 274 incarcerated adult females. Results revealed that psychopathic and BPD traits were differentially related to alcohol and drug use. Specifically, unique variance in BPD traits was related to alcohol use, whereas unique variance in lifestyle-antisocial psychopathic traits was related to drug use. Findings support unique relationships between psychopathic and BPD traits and problematic and prolonged alcohol and drug use in incarcerated adult females. Results may inform methods of tailoring specific substance use treatments for use in females with distinct personality profiles.

The relationship between psychopathic traits and risky sexual behavior in incarcerated adult male offenders.

Individuals scoring high on psychopathic traits engage in various forms of risky behavior. However, the relationship between psychopathic traits and risky sexual behavior (RSB) is less understood, especially with participants recruited from incarcerated settings. Here, we investigated the relationship between RSB and psychopathic traits with n = 179 incarcerated adult male offenders who completed a self-report RSB questionnaire asking participants about their lifetime number of sexual partners and frequency of using a condom during sex. Psychopathic traits were assessed using the Hare Psychopathy Checklist - Revised (PCL-R). In independent-samples t-tests, participants scoring high on psychopathic traits (i.e., PCL-R total score ≥ 30) reported greater total number of sexual partners throughout their lifetime and were less likely to use a condom during sex compared to low-scorers (i.e., PCL-R total score ≤ 15). In multiple regression analyses, PCL-R total scores emerged as a significant predictor of reduced condom usage during sex, but covariate measures assessing general externalizing psychopathology, did not. Our results suggest that several public health concerns, including sexually transmitted infection transmittal and unwanted pregnancies, may arise due to individuals scoring higher on psychopathy engaging in risky sexual behavior to a greater extent compared to those scoring lower on psychopathy.

Affective and interpersonal psychopathic traits associated with reduced corpus callosum volume among male inmates - RETRACTED.

BACKGROUND: Psychopathy is a personality disorder associated with severe emotional and interpersonal consequences and persistent antisocial behavior. Neurobiological models of psychopathy emphasize impairments in emotional processing, attention, and integration of information across large-scale neural networks in the brain. One of the largest integrative hubs in the brain is the corpus callosum (CC) - a large white matter structure that connects the two cerebral hemispheres. METHOD: The current study examines CC volume, measured via Freesurfer parcellation, in a large sample (n = 495) of incarcerated men who were assessed for psychopathic traits using the Hare Psychopathy Checklist-Revised (PCL-R). RESULTS: Psychopathy was associated with reduced volume across all five sub-regions of the CC. These relationships were primarily driven by the affective/interpersonal elements of psychopathy (PCL-R Factor 1), as no significant associations were found between the CC and the lifestyle/antisocial traits of psychopathy. The observed effects were not attributable to differences in substance use severity, age, IQ, or total brain volume. CONCLUSIONS: These findings align with suggestions that core psychopathic traits may be fostered by reduced integrative capacity across large-scale networks in the brain.

Sporting activity is reduced following medial reefing performed for patellar dislocation : A retrospective case series of 144 patients with a minimum follow-up of 24 months.

BACKGROUND: Patellar dislocation is common in young and active patients. The purpose of this study was to determine sporting activity following the medial reefing of patellar dislocation. METHODS: One hundred forty-four patients with objective patellar dislocation were treated between 2004 and 2013. Three groups were analyzed retrospectively with a minimum follow-up of 24 months: (1) primary dislocation that was treated with medial reefing without a recurrent dislocation until the day of follow-up (n = 74), (2) primary dislocation that was initially treated with medial reefing but with a recurrent dislocation until the day of follow-up (n = 44), and (3) medial reefing after failed conservative treatment (n = 26). Sporting activity was assessed using a widely-used sporting activity questionnaire and the Tegner score prior to the injury and at the follow-up (58.7 ± 22.6 months after the injury). Clinical outcomes were assessed using IKDC and Kujala score. RESULTS: The Kujala score was 94.7 ± 9.3 for Group 1, 84.1 ± 16.6 for Group 2 and 93.4 ± 9.7 for Group 3. IKDC at the time of follow-up was 97.2 ± 9.3 for Group 1, 86.1 ± 14.6 for Group 2 and 95.1 ± 11.1 for Group 3. 91.9% of Group 1 and 92.3% of Group 3 were active in sports prior to their injuries and at the time of the follow-up. In Group 2, sporting activity reduced from 81.8 to 75.0%. In all groups, a shift from high performance to recreational sports was found. CONCLUSIONS: Despite good clinical results, sporting activity was reduced following patellar dislocation treated with medial reefing. Also, a shift from engagement in high- to low-impact sports among the participants was noted.

[Georgia, a country of diverse aid from Germany in the ENT field]. / Georgien, ein Land vielfältiger Hilfen aus Deutschland auf dem HNO-Gebiet.

Following a long-term tradition, several teams of German ENT specialists are currently working in different Georgian clinics on a charitable basis. The current paper describes the structures of the medical and health insurance systems in this southern Caucasian country. The course of medical education for physicians in Georgia is portrayed and differences to the German situation which explain why young Georgian colleagues have difficulties when moving to Germany are highlighted. The paper describes the typical stay of a German ENT specialist in Georgia and also points out how these physicians are in turn supported in their charitable work by medical devices and equipment sent from Germany. Finally, the input that German colleagues can contribute to improving the situation in the Georgian health care system is discussed from the perspective of German ENT specialists and future goals of the cooperation between German and Georgian physicians are summarized.

Psychopathic traits associated with abnormal hemodynamic activity in salience and default mode networks during auditory oddball task.

Psychopathy is a personality disorder accompanied by abnormalities in emotional processing and attention. Recent theoretical applications of network-based models of cognition have been used to explain the diverse range of abnormalities apparent in psychopathy. Still, the physiological basis for these abnormalities is not well understood. A significant body of work has examined psychopathy-related abnormalities in simple attention-based tasks, but these studies have largely been performed using electrocortical measures, such as event-related potentials (ERPs), and they often have been carried out among individuals with low levels of psychopathic traits. In this study, we examined neural activity during an auditory oddball task using functional magnetic resonance imaging (fMRI) during a simple auditory target detection (oddball) task among 168 incarcerated adult males, with psychopathic traits assessed via the Hare Psychopathy Checklist-Revised (PCL-R). Event-related contrasts demonstrated that the largest psychopathy-related effects were apparent between the frequent standard stimulus condition and a task-off, implicit baseline. Negative correlations with interpersonal-affective dimensions (Factor 1) of the PCL-R were apparent in regions comprising default mode and salience networks. These findings support models of psychopathy describing impaired integration across functional networks. They additionally corroborate reports which have implicated failures of efficient transition between default mode and task-positive networks. Finally, they demonstrate a neurophysiological basis for abnormal mobilization of attention and reduced engagement with stimuli that have little motivational significance among those with high psychopathic traits.

Kinetic risk factors of running-related injuries in female recreational runners.

Our objective was to prospectively investigate the association of kinetic variables with running-related injury (RRI) risk. Seventy-four healthy female recreational runners ran on an instrumented treadmill while 3D kinetic and kinematic data were collected. Kinetic outcomes were vertical impact transient, average vertical loading rate, instantaneous vertical loading rate, active peak, vertical impulse, and peak braking force (PBF). Participants followed a 15-week half-marathon training program. Exposure time (hours of running) was calculated from start of program until onset of injury, loss to follow-up, or end of program. After converting kinetic variables from continuous to ordinal variables based on tertiles, Cox proportional hazard models with competing risks were fit for each variable independently, before analysis in a forward stepwise multivariable model. Sixty-five participants were included in the final analysis, with a 33.8% injury rate. PBF was the only kinetic variable that was a significant predictor of RRI. Runners in the highest tertile (PBF < -0.27 BW) were injured at 5.08 times the rate of those in the middle tertile and 7.98 times the rate of those in the lowest tertile. When analyzed in the multivariable model, no kinetic variables made a significant contribution to predicting injury beyond what had already been accounted for by PBF alone. Findings from this study suggest PBF is associated with a significantly higher injury hazard ratio in female recreational runners and should be considered as a target for gait retraining interventions.

Patient-reported outcome: results of the multicenter German post-market study.

PURPOSE: Upper airway stimulation (UAS) is an alternative second-line treatment option for patients with obstructive sleep apnea (OSA). In our substudy of a previous multicentre study of patients implanted with UAS, we focused on patient-related outcomes like Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire (FOSQ), snoring and personal satisfaction 6 and 12 months after the implantation. METHODS: 60 patients, who were initially non-adherent to CPAP and implanted with UAS, were included in a prospective multicentre study. Data were collected preoperative, 6 and 12 months after implantation regarding FOSQ, ESS, snoring, and their experience with the UAS device. RESULTS: Besides relevant Apnoea-Hypopnea Index (AHI) reduction, we saw significant improvements in ESS (p < 0.001), FOSQ (p < 0.001) and snoring under UAS therapy. A strong correlation between AHI results postoperative and the personal satisfaction of the patients after implantation was found as well as between usage results and AHI compared to the preoperative results. CONCLUSION: The more the patients benefit from UAS according to their self-reported outcome, the higher is the therapy use.

Differentiating emotional processing and attention in psychopathy with functional neuroimaging.

Individuals with psychopathy are often characterized by emotional processing deficits, and recent research has examined the specific contexts and cognitive mechanisms that underlie these abnormalities. Some evidence suggests that abnormal features of attention are fundamental to emotional deficits in persons with psychopathy, but few studies have demonstrated the neural underpinnings responsible for such effects. Here, we use functional neuroimaging to examine attention-emotion interactions among incarcerated individuals (n = 120) evaluated for psychopathic traits using the Hare Psychopathy Checklist-Revised (PCL-R). Using a task designed to manipulate attention to emotional features of visual stimuli, we demonstrate effects representing implicit emotional processing, explicit emotional processing, attention-facilitated emotional processing, and vigilance for emotional content. Results confirm the importance of considering mechanisms of attention when evaluating emotional processing differences related to psychopathic traits. The affective-interpersonal features of psychopathy (PCL-R Factor 1) were associated with relatively lower emotion-dependent augmentation of activity in visual processing areas during implicit emotional processing, while antisocial-lifestyle features (PCL-R Factor 2) were associated with elevated activity in the amygdala and related salience network regions. During explicit emotional processing, psychopathic traits were associated with upregulation in the medial prefrontal cortex, insula, and superior frontal regions. Isolating the impact of explicit attention to emotional content, only Factor 1 was related to upregulation of activity in the visual processing stream, which was accompanied by increased activity in the angular gyrus. These effects highlight some important mechanisms underlying abnormal features of attention and emotional processing that accompany psychopathic traits.

Pancreatic stellate cells in pancreatic cancer: In focus.

Pancreatic stellate cells are stromal cells that have multiple physiological functions such as the production of extracellular matrix, stimulation of amylase secretion, phagocytosis and immunity. In pancreatic cancer, stellate cells exhibit a different myofibroblastic-like morphology with the expression of alpha-smooth muscle actin, the activated form is engaged in several mechanisms that support tumorigenesis and cancer invasion and progression. In contrast to the aforementioned observations, eliminating the stromal cells that are positive for alpha-smooth muscle actin resulted in immune-evasion of the cancer cells and resulted in worse prognosis in animal models. Understanding the cancer-stromal signaling in pancreatic adenocarcinoma will provide novel strategies for therapy. Here we provide an updated review of studies that handle the topic "pancreatic stellate cells in cancer" and recent experimental approaches that can be the base for future directions in therapy.

Recent developments in the diagnosis and treatment of obstructive sleep apnea : English version.

Over the past few years, the diagnostic tools and therapeutic approaches for obstructive sleep apnea (OSA) have evolved further. Based on a review of the current literature and the personal experiences of the authors, the most relevant developments are summarized in this article and discussed with regard to their impact on the clinical management of the disease. In the third edition of the International Classification of Sleep Disorders, the classification of sleep-disordered breathing was modified. Notably, additional clinical criteria for the diagnosis of OSA were established and out-of-center sleep testing was introduced as an alternative to polysomnography. Recent technical advancements in diagnostic tools (e. g., peripheral arterial tonometry and pulse wave analysis) have further expanded the diagnostic possibilities. Drug-induced sleep endoscopy allows for a reliable assessment of the level and degree of upper airway obstruction. Whether this gain in diagnostic information leads to an improvement in surgical outcome is, however, still being discussed. The relevance of positional OSA has received increasing attention - the subgroup of patients in whom sleeping position significantly impacts their disease is reported to be above 50 %. For these patients, the introduction of the sleep position trainer offers a new therapeutic option. Further, hypoglossal nerve stimulation (upper airway stimulation) has substantially expanded the surgical spectrum for the treatment of OSA. In regard to the established surgical treatment options, randomized trials with superior methodology have been published, especially for bimaxillary advancement and tonsillectomy with uvulopalatopharyngoplasty. These developments are of particular interest for the otolaryngologist and will influence daily practice.

[Drug-induced sedation endoscopy-quo vadis? : Review and outlook]. / Medikamentös induzierte Schlafendoskopie ­ quo vadis? : Bestandsaufnahme und Ausblick.

BACKGROUND: Drug-induced sedation endoscopy (DISE) is a diagnostic procedure which allows evaluation of the collapsibility of the upper airway. According to expert opinion, it is possible to imitate nocturnal collapsibility and perform a realistic investigation of the site of obstruction and vibration. This should enable sufficient and precise therapeutic advice to be given solely on the basis of clinical assessment. OBJECTIVE: The current publication critically evaluates the present state of development of DISE and its potential indications. MATERIALS AND METHODS: A PubMed literature research was performed using "sleep" and "endoscopy" or "DISE" as keywords. Relevant publications were evaluated. RESULTS: The present publication provides a historical summary of the available publications and relates these to other methods for examining obstructive sleep apnea. The present state of DISE in terms of drugs applied, grading systems, and validity is evaluated. Indications for DISE are described and critically discussed on the basis of literature data. CONCLUSION: DISE provides deep insights into the genesis of obstructions of the upper airway and snoring. Although its value for diagnosis and treatment of sleep-disordered breathing could not yet be demonstrated for all non-CPAP (continuous positive airway pressure) therapies, DISE could identify predictive parameters some methods. Further potential indications for DISE might be predictive examinations for mandibular advancement devices and respiration-synchronous neurostimulation of the hypoglossal nerve. DISE will thus remain a valuable diagnostic tool for obstructive sleep apnea and rhonchopathy.