Drug-induced sleep endoscopy: a two drug comparison and simultaneous polysomnography

Abstract

The purpose of the present study was to compare pharyngeal and polysomnographical findings during drug-induced sleep endoscopy (DISE) performed with either propofol or midazolam as a single sedative agent. It is prospective, non-randomized, double-blinded case series study. Sixteen patients with sleep disordered breathing were sedated first with propofol and after full wake up with midazolam. Simultaneous polysomnography (PSG) was performed. We compared the zones of obstruction and vibration found with both drugs using the VOTE classification. Simultaneous PSG findings are also compared. There were 15 men and one woman; the mean age was 42.7 years old, mean body mass index 26.9 kg/m(2). Average DISE duration was 20 min with Propofol and 14.3 min with Midazolam. The induced sleep stage obtained was N2 with both drugs. Outpatient physical exam did not correlate with drug-induced sleep findings. There was a good correlation between DISE results with both drugs in all the areas of collapse except the velum (p < 0.005). Using a continuous perfusion, there is a good agreement in the findings observed in DISE performed with propofol and midazolam and PSG.

The Effect of Sedating Agents on Drug‐Induced Sleep Endoscopy Findings

“…Carrasco‐Llatas et al compared midazolam and propofol in the same patients with OSA and did not observe differences in the degree and pattern of obstruction sites, excepted the velum, thus opposing our findings. Yoon et al showed that in patients sedated with propofol and dexmedetomidine during DISE, the agreement and correlation regarding UA collapse was excellent for all obstruction sites regardless of whether light (65 to 75) or deep (50 to 60) sedation was used .…”

“…Different drugs have been used to induce sedation during DISE, including midazolam, propofol and dexmedetomidine . All drugs present specific advantages and disadvantages with differential effects on respiratory physiology …”

“…The therapeutic and adverse effects of midazolam are due to its action on the gamma‐aminobutyric acid (GABA) alpha receptors, which results in neural inhibition and consequently sedation, anterograde amnesia, and muscle relaxation . Although it has been described to induce higher pharyngeal muscle tone relaxation compared to propofol, at least one study has described similar effects …”

Insights since FDA Approval of Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea

“…Others, however, have compared propofol and, after recovery, with midazolam, finding that using a continuous perfusion, there is a good agreement; in this report, outpatient physical exam did not correlate with drug-induced sleep findings 44 . However, others believe that more work is needed to standardize the anesthesia side of DISE 45 .…”

Novel Surgical Approaches for the Treatment of Obstructive Sleep Apnea

“…2 When performed under specific conditions and guidelines, propofol-induced sedation correlates most closely with deeper levels (stage N2) of non-rapid eye movement (NREM) sleep and maintains a similar AHI as compared with physiologic sleep. 3,4 Studies of sleep endoscopy have demonstrated validity, test-retest reliability, and interrater reliability. 5,6 Recent data suggest that utilization of DISE can improve treatment outcomes with oral appliances.…”