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

Viana, Alonço; Zhao, Chen; Rosa, Talita D’Aguiar; Couto, Arnaldo Cézar; Neves, Denise Duprat; Araújo-Melo, Maria Helena de; Capasso, Robson

doi:10.1002/lary.27298

Cited by 34 publications

(35 citation statements)

References 51 publications

(107 reference statements)

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“…44,50 Dexmedetomidine was used for sedation, and differences in tongue base collapse related to propofol or midazolam use have already been identified. Nevertheless, the velum collapse pattern was similar in response to the three drugs, 51 enabling extension of the findings in this study to DISE with these drugs. (iii) In the sample, only OSA individuals intolerant to CPAP were evaluated, generating a selection bias, and not fully representing the general OSA population.…”

Section: Discussionsupporting

confidence: 58%

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Zhao

Viana

et al. 2020

NSS

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Identification of upper airway (UA) obstruction based on pharyngeal factors is important for obstructive sleep apnea (OSA) evaluation. This study is to assess the association between UA collapse characteristics and Friedman tongue position (FTP) in patients with OSA through drug-induced sleep endoscopy (DISE). Patients and Methods: Retrospective study in individuals with OSA who were intolerant to continuous positive airway pressure (CPAP) treatment, submitted to DISE between June 1, 2013, and July 31, 2017. All subjects were classified as having an FTP grade of I to IV, and the velum, oropharynx, tongue base, epiglottis (VOTE) classification was used to analyze the DISE findings. UA collapse characteristics by DISE and FTP grading were compared between groups. The associations between specific DISE findings and FTP were analyzed. Results: In total, 205 patients were assessed. A positive and significant correlation was identified between the presence of retropalatal complete concentric collapse (CCC) and FTP grade, according to the following distributions: I, 17.4%; II, 22.9%; III, 33.7%; and IV, 48.7% (P = 0.014). A logistic regression model revealed that CCC was associated with FTP grade IV. After adjusting for age, sex, body mass index (BMI), and tonsil size (TS), the grade IV individuals had a 4.4-fold higher risk of having CCC than grade I individuals (P = 0.026). Multiple collapse sites and palatopharyngeal or combined (palatopharyngeal and hypopharyngeal) collapse were more prevalent in grade IV individuals. Conclusion: OSA patients intolerant to CPAP have a strong positive correlation between the FTP grade and presence of retropalatal CCC. FTP grade IV is an independent risk factor for velum-CCC, controlling for sex, age, BMI, and TS grade.

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Section: Discussionsupporting

confidence: 58%

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Zhao

Viana

et al. 2020

NSS

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“…However, despite giving midazolam, the dexmedetomidine group showed lesser degree of collapse compared with the propofol group, therefore we feel that inclusion of these patients could not have affected the results grossly. Further, compared with a previous study demonstrating increase in collapse with midazolam, the dose used in the present trial was much smaller …”

Section: Discussioncontrasting

confidence: 54%

Dexmedetomidine versus propofol at different sedation depths during drug‐induced sleep endoscopy: A randomized trial

et al. 2019

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Objectives/Hypothesis: The aim of this study was to compare the effect of dexmedetomidine and propofol on airway dynamics, cardiorespiratory system, and emergence following drug-induced sleep endoscopy (DISE).Study Design: Prospective, randomized, single-blinded study. Methods: Sixty patients age 18 to 65 years in American Society of Anesthesiologists physical status groups 1 and 2 scheduled to undergo DISE were randomly allocated to either Group P (N = 30; receiving propofol infusion at 50-150 μg/kg/min) or Group D (N = 30; receiving dexmedetomidine bolus of 1 μg/kg followed by infusion at 0.5-1.0 μg/kg/hr). DISE was done at light sleep and deep sleep. Airway obstruction at tongue base was recorded as primary outcome. Airway obstruction at velum, oropharyngeal lateral wall, and epiglottis level during light and deep sedation, hemodynamic and respiratory parameters, time to attain sufficient sedation, time for emergence from sedation, and any adverse events during DISE with the two study drugs were recorded as secondary outcomes.Results: There was a greater degree of obstruction at the tongue base level (P = 0.001) and Oropharynx level (P = 0.017) in Group P compared with Group D during deep sedation. Increase in airway obstruction from light to deep sleep was seen with propofol at the oropharynx (P = 0.0185) and tongue base (P = 0.0108) levels. Two patients (6.6%) in Group D and 10 patients (33.3%) in Group P showed oxygen saturation below the minimum oxygen saturation recorded during polysomnography. Time to open eyes to call after stopping sedation was significantly less in Group P (P = 0.005).Conclusions: Dexmedetomidine shows a lesser degree of airway collapse and higher oxygen saturation levels at greater sedation depth during DISE. Propofol has a faster onset and emergence from sedation.

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“…6 However, some controversy surrounds the type and dose of sedative drug, [7][8][9][10] the best classification to describe the findings, 11 the interrater and intrarater reliability of DISE findings, 12,13 and the differences in obstruction patterns between drug-induced sleep and natural sleep. 14,15 Many previous studies have attempted to address the controversies associated with the choice of sedative drug (midazolam vs propofol vs midazolam plus propofol), 9,10,16 the best classification system for the findings (NOHL classification [nose, oropharynx, hypopharynx, and larynx] or VOTE [velum, oropharynx, tongue base, and epiglottis] classification), 11 and the interrater and intrarater reliability of DISE findings. 12,13 However, to our knowledge, thus far no study has investigated the reliability of DISE findings in terms of their agreement with natural sleep endoscopy (NSE) findings.…”

mentioning

confidence: 99%

Obstruction Patterns During Drug-Induced Sleep Endoscopy vs Natural Sleep Endoscopy in Patients With Obstructive Sleep Apnea

Park

Kim

Heo

2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Drug-induced sleep endoscopy (DISE) has been suggested to be a valuable technique for identifying the obstruction site associated with sleep-disordered breathing. However, the reliability of DISE findings is controversial because the procedure uses sedative drugs, which may have implications for the obstruction patterns observed on DISE. OBJECTIVE To compare the obstruction patterns during DISE with the obstruction patterns during natural sleep endoscopy (NSE).

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

Abstract: 4. Laryngoscope, 2018.

Cited by 34 publications

References 51 publications

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

<p>High Tongue Position is a Risk Factor for Upper Airway Concentric Collapse in Obstructive Sleep Apnea: Observation Through Sleep Endoscopy</p>

Dexmedetomidine versus propofol at different sedation depths during drug‐induced sleep endoscopy: A randomized trial

Obstruction Patterns During Drug-Induced Sleep Endoscopy vs Natural Sleep Endoscopy in Patients With Obstructive Sleep Apnea

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