title: Variable Findings for Drug-Induced Sleep Endoscopy in Obstructive Sleep Apnea with Propofol versus Dexmedetomidine.
abstract: OBJECTIVE
  To compare VOTE classification findings (velum, oropharyngeal-lateral walls, tongue base, and epiglottis) for drug-induced sleep endoscopy (DISE) among patients with obstructive sleep apnea (OSA) using 2 sedation protocols.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Single tertiary institution.
  
  
  METHODS
  Patients with OSA who underwent DISE.
  
  
  METHODS
  A total of 216 patients underwent DISE between November 23, 2011, and May 1, 2015. DISE findings based on VOTE classification were compared between patients receiving the propofol- and dexmedetomidine-based sedation protocols.
  
  
  RESULTS
  Patients with OSA (N = 216; age, 44.3 ± 11.7 years; body mass index, 27.9 ± 4.8 kg/m(2)) underwent DISE with intravenous administration of propofol (n = 52) or dexmedetomidine (n = 164). There were no statistically significant differences between the 2 groups in baseline apnea-hypopnea index, oxygen desaturation index, Mallampati score, tonsil size, Epworth Sleepiness Scale score, peripheral oxygen saturation nadir, age, sex, or body mass index. Patients in the propofol group had a significantly increased likelihood of demonstrating complete tongue base obstruction (75%, 39 of 52) versus partial or no obstruction (25%, 13 of 52) in the anterior-posterior dimension, as compared with the dexmedetomidine group (complete obstruction: 42.7%, 70 of 164; partial or no obstruction: 57.3%, 94 of 164; odds ratio: 4.0; 95% confidence interval: 2.0-8.1; P = .0001). Obstruction of other airway subsites was not significantly different.
  
  
  CONCLUSIONS
  Use of propofol versus dexmedetomidine to induce sedation may have a significant effect on the pattern of upper airway obstruction observed during DISE. Randomized prospective studies are indicated to confirm these initial findings.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University, Stanford, California, USA rcapasso@ohns.stanford.edu.
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University, Stanford, California, USA.
authors.forename: Talita
authors.initials: T
authors.lastname: Rosa
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University, Stanford, California, USA Department of Otolaryngology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: David Yung-An
authors.initials: DY
authors.lastname: Tsou
authors.affiliation: Department of Anesthesiology, Stanford University, Stanford, California, USA.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Nekhendzy
authors.affiliation: Department of Anesthesiology, Stanford University, Stanford, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Drover
authors.affiliation: Department of Anesthesiology, Stanford University, Stanford, California, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Collins
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University, Stanford, California, USA.
authors.forename: Soroush
authors.initials: S
authors.lastname: Zaghi
authors.affiliation: Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, O'ahu, Hawaii, USA Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University, Redwood City, California, USA.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
mesh_terms: D000328:Adult; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D012890:Sleep / Q000187:drug effects; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol
keywords: VOTE classification; dexmedetomidine; obstructive sleep apnea; propofol; sleep endoscopy