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Propofol Application Rate Pattern Found Suitable for Performing Sedation-Controlled DISE in Patients with Obstructive Sleep Apnea and/or Snoring 

by Linda Kossoff •

CLINICAL QUESTION

What are the influences of different rates of propofol application on the achieved depth and length of the sedation course during drug-induced endoscopy (DISE)?

BOTTOM LINE

Lower application rates of propofol provide slower courses and shallower depths of sedation. 

BACKGROUND: Regarding the performance of DISE, there is published evidence that the levels, patterns, and intensity of upper airway collapse can change depending on the depth of sedation. Even with the use of a single sedative, results of DISE may vary depending on the dose and flow rate of the applied drug.

STUDY DESIGN: Prospective study

SETTING: Department of Otorhinolaryngology–Head and Neck Surgery Carl-Thiem-Klinikum, Cottbus, Germany

SYNOPSIS: Researchers enrolled 63 patients (47 males, mean age 49.86 years) with documented obstructive sleep apnea (OSA) and/or snoring undergoing DISE between November 2019 and August 2021. They aimed to test five predictors as influencing factors for depth of sedation: application rate, gender, age, body mass index (BMI), and apnea–hypopnea index (AHI). The patients’ mean BMI was 30.22, and the mean AHI was 27.17. Participants were randomly sedated by propofol perfusion at seven application patterns. Sedation depth was monitored by the Bispectral Index (BIS), which ranges from 100 to 0 (maximal alertness at BIS 100; maximal sedation at 0). The propofol application rate was the only factor influencing the depth of sedation. Regimes at 14 and 16 mg/kg/h as well as bolus application did not reach BIS levels below 50, representing deep sleep. Propofol doses of more than 20 mg/kg/h led to rapid decreases in sedation levels below deep sleep levels. Propofol rates between 18 and 20 mg/kg/h enabled BIS levels below 50, representing deep sleep and providing enough breathing cycles for observation. Results suggest that a combination of 14 and 18 mg/kg/h might be a suitable pattern for performing sedation-controlled DISE. Study limitations included a limited number of participants.

CITATION: Polievoi Y, Grafmans D, Skliar M, et al. The influence of different application patterns of propofol on the sedation courses during drug-induced sleep endoscopy. Laryngoscope Investig Otolaryngol. 2024;9:e1258.