Target-Controlled Infusion of Propofol-Induced Sleep Endoscopy for Patients with Obstructive Sleep Apnea

Abstract

Objectives:

Drug-induced sleep endoscopy (DISE) allows inspection of upper airway to accurately localize the anatomical region that collapses in obstructive sleep-apnea-hypopnea syndrome (OSAHS). The sedation technique adopted in most centers throughout Europe is the target controlled infusion (TCI) of propofol without oxygen supply. The goal of this paper is to compare the advantages of supplemental oxygen during this procedure.

Methods:

Medical records of 61 patients diagnosed with OSAHS by full-night PSG who underwent drug-induced sleep endoscopy (DISE) with propofol to evaluate the upper airway were retrospectively reviewed. No patients were on any premedication preoperatively before DISE. Besides applying standard anesthetic monitors, a bispectral index monitor (BIS) Quatro sensor was positioned on the forehead as per manufacturer’s instructions. If patients had brisk response of limb movement, the sedative dosage was adjusted by specialized anesthesiologists. The demographic variables of age, gender, BMI and intraoperative presentations of effect site concentration of Propofol ((µg/mL)), BIS level, infusion time, and involuntary movement were collected for analysis.

Results:

By achieving the same level of sedation detected by the BIS monitor, the severe OSAHS patients needed a higher effect site concentration of propofol (5.3 ± 1.1 μg/mL in severe OSAHS vs. 4.5 ± 1.4 μg/mL in mild/moderate OSAHS, p=0.025, Mann-Whitney U test) and obviously involuntary movement. No adverse effects or complications were noted during this procedure.

Conclusions:

Target controlled infusion of Propofol-induced sleep endoscopy for OSA patients is a feasible and safe procedure. Severe OSAHS patients experienced worse saturation during overnight sleep and obviously involuntary response in sedated endoscopy even with higher predicted concentration of Propofol.