Variable Findings for Drug-Induced Sleep Endoscopy in Obstructive Sleep Apnea with Propofol versus Dexmedetomidine

被引:46
作者
Capasso, Robson [1 ]
Rosa, Talita [1 ]
Tsou, David Yung-An [1 ,2 ]
Nekhendzy, Vladimir [3 ]
Drover, David [3 ]
Collins, Jeremy [3 ]
Zaghi, Soroush [1 ]
Camacho, Macario [4 ,5 ]
机构
[1] Stanford Univ, Dept Otolaryngol Head & Neck Surg, Div Sleep Surg, Stanford, CA 94305 USA
[2] China Med Univ Hosp, Dept Otolaryngol, Taichung, Taiwan
[3] Stanford Univ, Dept Anesthesiol, Stanford, CA 94305 USA
[4] Tripler Army Med Ctr, Div Sleep Surg & Med, Dept Otolaryngol, Oahu, HI USA
[5] Stanford Univ, Dept Otolaryngol, Div Sleep Med, Redwood City, CA USA
关键词
propofol; dexmedetomidine; sleep endoscopy; obstructive sleep apnea; VOTE classification; INDUCED SEDATION ENDOSCOPY; UPPER AIRWAY MORPHOLOGY; INCREASING DEPTH; MULLER MANEUVER; ANESTHESIA; MIDAZOLAM; MANAGEMENT; EFFICACY; AWAKE;
D O I
10.1177/0194599815625972
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Objective To compare VOTE classification findings (velum, oropharyngeal-lateral walls, tongue base, and epiglottis) for drug-induced sleep endoscopy (DISE) among patients with obstructive sleep apnea (OSA) using 2 sedation protocols. Study Design Case series with chart review. Setting Single tertiary institution. Subjects Patients with OSA who underwent DISE. Methods A total of 216 patients underwent DISE between November 23, 2011, and May 1, 2015. DISE findings based on VOTE classification were compared between patients receiving the propofol- and dexmedetomidine-based sedation protocols. Results Patients with OSA (N = 216; age, 44.3 11.7 years; body mass index, 27.9 +/- 4.8 kg/m(2)) underwent DISE with intravenous administration of propofol (n = 52) or dexmedetomidine (n = 164). There were no statistically significant differences between the 2 groups in baseline apnea-hypopnea index, oxygen desaturation index, Mallampati score, tonsil size, Epworth Sleepiness Scale score, peripheral oxygen saturation nadir, age, sex, or body mass index. Patients in the propofol group had a significantly increased likelihood of demonstrating complete tongue base obstruction (75%, 39 of 52) versus partial or no obstruction (25%, 13 of 52) in the anterior-posterior dimension, as compared with the dexmedetomidine group (complete obstruction: 42.7%, 70 of 164; partial or no obstruction: 57.3%, 94 of 164; odds ratio: 4.0; 95% confidence interval: 2.0-8.1; P = .0001). Obstruction of other airway subsites was not significantly different. Conclusion Use of propofol versus dexmedetomidine to induce sedation may have a significant effect on the pattern of upper airway obstruction observed during DISE. Randomized prospective studies are indicated to confirm these initial findings.
引用
收藏
页码:765 / 770
页数:6
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