Change of obstruction level during drug‐induced sleep endoscopy according to sedation depth in obstructive sleep apnea

Hong, Sang Duk; Dhong, Hun‐Jong; Kim, Hyo Yeol; Sohn, Jung Hyeob; Jung, Yong Gi; Chung, Seung‐Kyu; Park, Ju Yeon; Kim, Jin Kyoung

doi:10.1002/lary.24045

Cited by 62 publications

(48 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Eighteen snorers, 30 mild (AHI: 5-15), 30 moderate (AHI: [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], and 30 severe (AHI: > 30) OSA patients were enrolled in this study. Sixty-six patients with OSA (73.3%) were male.…”

Section: Resultsmentioning

confidence: 99%

“…Even when using propofol TCI, the BIS values, while performing DISE, were found to vary from 44 to 98. 24 Hong et al 16 recently demonstrated that the upper airway narrowed with deeper sedation according to BIS level (above 70 versus below 70) in a small number of cases. The current study set a narrower sedative range to yield greater reproducibility.…”

Section: A B C D E F G H Discussionmentioning

confidence: 99%

“…15 Recently, Hong et al 16 also revealed that different BIS levels had different degrees of upper airway narrowing by repeated DISE in the same patient but different BIS level.…”

Section: Bispectral Index In Evaluating Effects Of Sedation Depth On mentioning

confidence: 99%

See 2 more Smart Citations

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

Wang

et al. 2015

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

achieve a target effect site (brain) concentration of propofol. However, patients may lose consciousness at variable effect site concentrations (Ce), with a higher Ce being associated with higher upper airway critical closing pressure.6,7 Most DISE procedures are started shortly after the patients lose consciousness. Objective:To evaluate the effect of sedation depth on druginduced sleep endoscopy (DISE). Methods: Ninety patients with obstructive sleep apnea (OSA) and 18 snorers underwent polysomnography and DISE under bispectral index (BIS)-guided propofol infusion at two different sedation levels: BIS 65-75 (light sedation) and 50-60 (deep sedation). Results: For the patients with OSA, the percentages of velopharynx, oropharynx, hypopharynx, and larynx obstructions under light sedation were 77.8%, 63.3%, 30%, and 33.3%, respectively. Sedation depth was associated with the severity of velopharynx and oropharynx obstruction, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse. In comparison, OSA severity was associated with the severity of velopharynx obstruction, severity of oropharynx obstruction, and arytenoid prolapse (odds ratio (95% confi dence interval); 14.3 (4.7-43.4), 11.7 (4.2-32.9), and 13.2 (2.8-62.3), respectively). A good agreement was noted between similar DISE fi ndings at different times and different observers (kappa value 0.6 to 1, respectively 1 Drug-induced sleep endoscopy (DISE) has been used for decades to directly examine the upper airways in sedative-induced sleep and improve treatment outcomes by acting as an adjuvant tool to assess surgical or nonsurgical treatment options. 2-4Various sedation methods have been used to allow for the performance of DISE. Roblin introduced target-controlled infusion (TCI) of propofol to DISE to allow for better control of the sedation level.5 TCI of propofol uses computer-based pharmacokinetic and pharmacodynamic models to predict and Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep EndoscopyYu-Lun Lo, MD BRIEF SUMMARYCurrent Knowledge/Study Rationale: Drug-induced sleep endoscopy (DISE) were performed under different sedative conditions and might affect upper airway obstructions. We aimed to evaluate the affects of sedation depth and obstructive sleep apnea severity on different upper airway obstruction patterns. Study Impact: Under DISE, sedation depth affected velopharynx and oropharynx obstruction severity, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse; however, OSA severity was associated with velopharynx and oropharynx obstruction severity as well as arytenoid prolapse. Bispectral index guided DISE offers an objective and reproducible method to evaluate upper airway collapsibility.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: A B C D E F G H Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

Wang

et al. 2015

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 99%

“…Although prior investigations have examined the relationship of BIS during sedation and natural sleep, as well as the effects of sedation on airway obstruction, the results have not been consistent. [5][6][7][8] While BIS levels decrease during natural sleep in much the same way as during sedation, the technology does not allow for discrimination of different stages of sleep. 9 Furthermore, BIS scores associated with depth of anesthesia are dependent upon the anesthetic agent being used, are relatively ineffective during sedation with ketamine, nitrous oxide, or dexmedetomidine, and can be unpredictable in the presence of opioids.…”

mentioning

confidence: 99%

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy: DISE or No Dice

Stierer

Ishman

2015

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

British otolaryngologists Pringle and Croft fi rst introduced drug-induced sleep endoscopy (DISE) in 1991 as a technique to identify the anatomic location of obstruction in the airway of patients with snoring and obstructive sleep apnea. 1Since then, DISE, or sleep nasendoscopy, has been widely adopted as a diagnostic tool for dynamic airway evaluation. This technique is complementary to polysomnographic data, as it is used to differentiate the site of obstruction. DISE is commonly utilized to direct subsequent management, including selection of specifi c surgical interventions; however, there remains a general lack of agreement regarding standardization of the technique.3 Areas requiring more investigation include an optimal and standard scoring system as well as a standardized sedation protocol.In this issue of JCSM, the article by Lo et al. proposes a standardized sedation model for DISE using a propofol infusion guided by a bispectral index (BIS) monitor. 4 The authors suggest that sedation maintained at a BIS level of 65-75 provides an objective target to create the ideal conditions for DISE. The BIS level is not a physiologic measurement, but rather a dimensionless number derived from a proprietary algorithm that integrates multiple electroencephalogram tracings. Although prior investigations have examined the relationship of BIS during sedation and natural sleep, as well as the effects of sedation on airway obstruction, the results have not been consistent. [5][6][7][8] While BIS levels decrease during natural sleep in much the same way as during sedation, the technology does not allow for discrimination of different stages of sleep.9 Furthermore, BIS scores associated with depth of anesthesia are dependent upon the anesthetic agent being used, are relatively ineffective during sedation with ketamine, nitrous oxide, or dexmedetomidine, and can be unpredictable in the presence of opioids. 10And fi nally, in the B-Unaware trial, BIS was found to be ineffective in guiding the administration of volatile anesthetics. 11Moreover, BIS was not sensitive enough to detect clinically signifi cant changes in minimum alveolar concentration and suffered from interpatient variability .The Lo study 4 investigated the effect of sedation on DISE fi ndings and found that deep sedation levels (BIS levels of 50 to 60) resulted in greater airway collapsibility and more complete collapse at multiple sites than did evaluation at light sedations levels (BIS levels of 65 to 75). They also found that DISE fi ndings were consistent over 2 separate periods at each sedation level (deep and light). Real-time and video evaluation of DISE fi ndings were also shown to have a high level of interrater reliability. However, there is no comment on the therapy recommended by this evaluation or correlation with outcomes after these therapies were carried out. In addition, there was no comment on the correlation between BIS levels and clinical symptoms. This makes it diffi cult to generalize these fi ndings to situations when DISE is performed w...

show abstract

Lateral pharyngeal wall collapse associated with hypoxemia in obstructive sleep apnea

et al. 2015

View full text Add to dashboard Cite

show abstract

Change of obstruction level during drug‐induced sleep endoscopy according to sedation depth in obstructive sleep apnea

Abstract: The degree of upper airway narrowing can be aggravated according to the sedation depth. The monitoring of sedation depth during DISE is critical, especially in patients with mouth breathing.

Cited by 62 publications

References 24 publications

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy: DISE or No Dice

Lateral pharyngeal wall collapse associated with hypoxemia in obstructive sleep apnea

Contact Info

Product

Resources

About