A Clinical Comparative Study of Schnider and Eleveld Pharmacokinetic-Pharmacodynamic Models for Propofol Target-Controlled Infusion Sedation in Drug-Induced Sleep Endoscopy

Background: Optimizing sedative techniques for drug-induced sleep endoscopy (DISE) enhances accuracy and reproducibility in tailoring treatment for obstructive sleep apnea (OSA). The Schnider and Eleveld pharmacokinetic-pharmacodynamic (PK-PD) models, which predict propofol concentration in effect-site compartment based on patient-specific parameters, were utilized to guide intravenous sedation in this study. We compared the effectiveness of propofol sedation guided by the novel general-purpose Eleveld model versus the Schnider model using target-controlled infusion (TCI) systems. Methods: We investigated twenty-five adult OSA patients, randomized into two groups: the Schnider model group (n = 12) and the Eleveld model group (n = 13). DISE was conducted following standardized protocols, targeting effect-site concentration TCI mode. Data concerning sedation levels, effect-site concentration of propofol, procedural timing, propofol dosages, respiratory and cardiovascular parameters, and any procedural incidents were collected. Results: DISE was performed successfully in all enrolled patients from both groups. A significant difference was observed in the effect-site concentration of propofol (CeP) at the moment of endoscopy between the Eleveld and Schnider groups (2.1 +/- 0.4 mu g/mL vs. 3.3 +/- 0.7 mu g/mL, respectively; p < 0.001). The E group also demonstrated a shorter time to attain the optimal sedation plane compared to the S group (6.1 +/- 1.7 vs. 9.8 +/- 2.2 min, respectively; p < 0.001) and a reduced total procedural time (11.2 +/- 1.4 vs. 15.0 +/- 2.1 min, respectively; p < 0.001). The incidence of adverse events was comparable between groups. Conclusions: The Eleveld model demonstrated a shorter time to achieve the optimal sedation plane, a shorter total procedural time, and a significant difference in effect-site concentration at the time of endoscopy compared to the Schnider model. The incidence of adverse events was comparable between the two groups, suggesting that the Eleveld model may offer improved efficiency without compromising safety during DISE.