Depth-dependent changes of obstruction patterns under increasing sedation during drug-induced sedation endoscopy: results of a German monocentric clinical trial.
OBJECTIVE
Drug-induced sedation endoscopy (DISE) and simulated snoring (SimS) can locate the site of obstruction in patients with sleep-disordered breathing (SDB). There is clinical evidence for a change in collapsibility of the upper airway depending on the depth of sedation. So far, a dose-response relationship between sedation and collapsibility has not been demonstrated.


METHODS
DISE and SimS were performed in 60 consecutive patients with SDB under monitoring of depth of sedation by BiSpectral Index® (BIS). Initially, SimS was conducted followed by DISE using bolus application of propofol. Sedation was performed up to a sedation level representing slow wave sleep (BIS = 40). The collapsibility of the upper airway was documented at decreasing sedation levels by an identical pictogram classification.


RESULTS
For all levels and patterns of obstruction, a dose-dependent increase in the collapsibility of the upper airway was detected. A maximum collapsibility was achieved at sedation levels representing slow wave sleep. The collapsibility during SimS corresponded to light sleep stages and did not cover slow wave sleep.


CONCLUSIONS
A dose-dependent change of patterns of obstructions can be observed during DISE under BIS monitoring indicating sedation depth. The obtained patterns of obstruction during DISE and SimS should thus be interpreted with regard to the sedation depth.
Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 16, 23538, Lübeck, Germany.|Department of Anesthesiology and Surgical Intensive Care, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Germany.
Patrick
P
Kellner
Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
Beatrice
B
Herzog
Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
Sebastian
S
Plößl
Department of Otorhinolaryngology, Head and Neck Surgery, Franz-Joseph-Strauß-Allee 11, 93053, Regensburg, Germany.
Christian
C
Rohrmeier
Department of Otorhinolaryngology, Head and Neck Surgery, Franz-Joseph-Strauß-Allee 11, 93053, Regensburg, Germany.
Thomas
T
Kühnel
Department of Anesthesiology and Surgical Intensive Care, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Germany.
Ramona
R
Wanzek
Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
Stefan
S
Plontke
Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany. hno@ctk.de.|Department of Otorhinolaryngology Head and Neck Surgery, Carl-Thiem-Klinikum gGmbH, Carl-Thiem-Str. 111, 03048, Cottbus, Germany. hno@ctk.de.
Michael
M
Herzog
D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis* / Q000503:physiopathology; D000771:Anesthesia, Intravenous; D004305:Dose-Response Relationship, Drug; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010159:Palate / Q000503:physiopathology; D010614:Pharynx / Q000503:physiopathology; D017286:Polysomnography; D015742:Propofol; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D012894:Sleep Stages / Q000187:drug effects; D012913:Snoring / Q000503:physiopathology; D014059:Tongue / Q000503:physiopathology; D014609:Uvula / Q000503:physiopathology
D015742:Propofol
BIS; DISE; Drug-induced sedation endoscopy; Propofol; Sedation depth; Simulated snoring