title: Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy.
abstract: OBJECTIVE
  To evaluate the effect of sedation depth on drug-induced 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% confidence 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 findings at different times and different observers (kappa value 0.6 to 1, respectively). A high percentage of arytenoid prolapse (46.7% among the patients with OSA under light sedation) was noted.
  
  
  CONCLUSIONS
  Greater sedative depth increased upper airway collapsibility under DISE assessment. DISE under BIS-guided propofol infusion, and especially a level of 65-75, offers an objective and reproducible method to evaluate upper airway collapsibility. Some findings were induced by drug sedation and need careful interpretation. Specific arytenoid prolapse patterns were noted for which further investigations are warranted.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov, identifier: NCT01100554.
  
  
  CONCLUSIONS
  A commentary on this article appears in this issue on page 965.
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.|Healthcare Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Yu-Lun
authors.initials: YL
authors.lastname: Lo
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.|Department of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
authors.forename: Yung-Lun
authors.initials: YL
authors.lastname: Ni
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.
authors.forename: Tsai-Yu
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.
authors.forename: Hsueh-Yu
authors.initials: HY
authors.lastname: Li
authors.affiliation: Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: David P
authors.initials: DP
authors.lastname: White
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Chang Gung University, School of Medicine, Taipei, Taiwan.
authors.forename: Jr-Rung
authors.initials: JR
authors.lastname: Lin
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.
authors.forename: Han-Pin
authors.initials: HP
authors.lastname: Kuo
mesh_terms: D016292:Procedural Sedation; D054810:Deep Sedation; D004562:Electrocardiography / Q000706:statistics & numerical data*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010614:Pharynx / Q000187:drug effects / Q000503:physiopathology; D017286:Polysomnography; D015742:Propofol / Q000494:pharmacology; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology*; D012913:Snoring / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: bispectral index; drug-induced sleep endoscopy; laryngeal obstruction; obstructive sleep apnea