title: Drug-induced sleep endoscopy with target-controlled infusion using propofol and monitored depth of sedation to determine treatment strategies in obstructive sleep apnea.
abstract: BACKGROUND
  Drug-induced sleep endoscopy (DISE) has become an important diagnostic examination tool in the treatment decision process for surgical therapies in the treatment of obstructive sleep apnea (OSA). Currently, there is a variety of regimes for the performance of DISE, which renders comparison and assessment across results difficult. It remains unclear how the different regimes influence the findings of the examination and the resulting conclusions and treatment recommendations. This study aimed to investigate the correlation between increasing levels of sedation (i.e., light, medium, and deep) induced by propofol using a target-controlled infusion (TCI) pump, with the obstruction patterns at the levels of the velum, oropharynx, tongue base, and epiglottis (i.e., VOTE classification). A second goal was the establishment of a sufficient sedation level to enable a reliable decision regarding treatment recommendations.
  
  
  METHODS
  Forty-three patients with OSA underwent a DISE procedure using propofol TCI. Three levels of sedation were defined, depending on entropy levels and assessment of sedation: light sedation, medium sedation, and deep sedation. The evaluation of the upper airway at each level, with increasing sedation, was documented using the VOTE classification. The elapsed time at which each assessment was performed was recorded.
  
  
  RESULTS
  Upper airway changes occurred and were measured throughout the DISE procedure. Clinically useful determinations of airway closure occurred at medium sedation; this level of sedation was most probably achieved with a blood propofol concentration of 3.2 μg/ml. In all 43 patients, definite treatment decisions could be made at medium sedation level. Increasing sedation did not result in changes in the treatment decision.
  
  
  CONCLUSIONS
  Changes in upper airway collapse during DISE with propofol TCI occur at levels of medium sedation. Decisions regarding surgical treatment could be made at this level of sedation.
  Upper Airway Collapse in Patients with Obstructive Sleep Apnea Syndrome by Drug Induced Sleep Endoscopy (URL: https://clinicaltrials.gov/ct2/results?term=NCT02588300&Search=Search ) REGISTRATION NUMBER: NCT02588300.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. hno@heiser-online.com.
authors.forename: Clemens
authors.initials: C
authors.lastname: Heiser
authors.affiliation: Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Phillippe
authors.initials: P
authors.lastname: Fthenakis
authors.affiliation: Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hapfelmeier
authors.affiliation: Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Berger
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Hofauer
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Alfried-Krupp-Krankenhaus, Essen, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Hohenhorst
authors.affiliation: Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Eberhard F
authors.initials: EF
authors.lastname: Kochs
authors.affiliation: Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Wagner
authors.affiliation: Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Guenther M
authors.initials: GM
authors.lastname: Edenharter
mesh_terms: D000758:Anesthesia / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage* / Q000494:pharmacology*; D011446:Prospective Studies; D012890:Sleep / Q000187:drug effects; D020181:Sleep Apnea, Obstructive / Q000628:therapy*
chemical_list: D015742:Propofol
keywords: Anesthesia; DISE; Drug-induced sleep endoscopy procedure; OSAS; Obstructive sleep apnea; Sedation