A Protocol for Propofol-Infusion Drug-Induced Sleep Endoscopy

Objective The objective of this study was to outline a protocol utilizing propofol infusion without an initial bolus during drug-induced sleep endoscopy (DISE). We define normative values for final propofol infusion rate (P-final) during DISE and sedation depth values at P-final. Study Design Retrospective chart review. Setting Tertiary academic hospital. Methods A review of patients with obstructive sleep apnea who underwent DISE between 2016 and 2020 was performed. The following patient data were recorded: demographics; DISE procedure details, including P-final, time to P-final, frequency and cadence of infusion rate changes, depth of sedation as measured by Bispectral Index and SedLine values, and hemodynamics; and polysomnography details including apnea-hypopnea index severity and minimum oxygen saturation. A mixed linear model adjusted for age and body mass index was performed for the analysis of effects on P-final. Pearson correlation coefficients determined the strength of association between depth of sedation measured and pattern of collapse on DISE and P-final. Results There were 246 patients who met inclusion criteria. P-final resembled a normal distribution (mean +/- SD, 156.44 +/- 26.69 mcg/kg/min; median, 150 mcg/kg/min). Analysis demonstrated that P-final was influenced by male sex, current smoker status, time to P-final, and number of propofol dose changes (P < .05). Depth of sedation categories measured differently between Bispectral Index and SedLine (55-65 vs 45-55, P < .001). The pattern including severity of collapse on DISE was not associated with P-final (P > .05). No patients required intra- or postoperative respiratory support beyond oxygen via nasal canula. Conclusion We describe a propofol slow-infusion DISE protocol that demonstrates safe and reproducible outcomes.