Drug-induced sleep endoscopy: conventional versus target controlled infusion techniques--a randomized controlled study.
Understanding the sites of pharyngeal collapse is mandatory for surgical treatment decision-making in obstructive sleep-apnea-hypopnea syndrome patients. Drug-induced sleep endoscopy (DISE) allows for the direct observation of the upper airway during sedative-induced sleep. In order to re-create snoring and apnea patterns related to a spontaneous sleep situation, the authors used a target-controlled infusion (TCI) sleep endoscopy (DISE-TCI), comparing this technique to conventional DISE, in which sedation was reached by a manual bolus injection. The authors conducted a prospective, randomized, unicenter study. The apneic event observation and its correlation with pharyngeal collapse patterns is the primary endpoint; secondary endpoints are defined as stability and safety of sedation plans of DISE-TCI technique. From January 2009 to June 2009, 40 OSAHS patients were included in the study and randomized allocated in two groups: the bolus injection conventional DISE group and the DISE-TCI group. We recorded the complete apnea event at the oropharynx and hypopharynx levels in 4 patients of the conventional DISE group (20%) and in 17 patients of the DISE-TCI group (85%) (P < 0.0001). Two patients needed oxygen in the conventional DISE group because of severe desaturation that resulted from the first bolus of propofol (1 mg/kg) (P = 0.4872 ns). We recorded the instability of the sedation plan in 13 patients from the conventional DISE group (65%) and 1 patient from the DISE-TCI group (5%) (P = 0.0001). Our results suggest that the DISE-TCI technique should be the first choice in performing sleep endoscopy because of its increased accuracy, stability and safety.
De Vito
Andrea
A
Head and Neck Surgery and Oral Surgery Unit, Department of Special Surgery, Morgagni-Pierantoni Hospital, Via Forlanini, 34, Forlì 47100, Italy. andrea_devito@fastwebnet.it
Agnoletti
Vanni
V
Berrettini
Stefano
S
Piraccini
Emanuele
E
Criscuolo
Armando
A
Corso
Ruggero
R
Campanini
Aldo
A
Gambale
Giorgio
G
Vicini
Claudio
C
D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012890:Sleep / Q000187:drug effects*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult
D018686:Anesthetics, Intravenous; D015742:Propofol
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