Drug-induced sleep endoscopy

Background. Obstructive sleep apnea (OSA) is a frequent disease. The underlying mechanism is a collapse of the upper airway at different levels that causes a partial or complete obstruction of the air flow. In recent years, drug-induced sleep endoscopy (DISE) has become an important diagnostic tool for OSA. Objectives. This article provides an overview of pharmacological characteristics of drugs used during DISE. Materials and Methods. Review Results. Medicinal sedation is indispensable for the performance of DISE. To date propofol and midazolam are the most commonly used drugs for this procedure, whereas the use of the new drug dexmedetomidine is mostly limited to clinical trials. For pharmacological reasons the individual dosage needed for midazolam varies significantly in different patients and monitoring time post intervention is considerably prolonged. Propofol on the other hand is quite short acting and its use via a target-controlled infusion (TCI) pump can improve interindividual comparability. Increasing doses of propofol can lead to prolonged apnea and cardiovascular depression. Dexmedetomidine seems to provoke a more sleep-like status compared to propofol and midazolam, though experiences in sedation with dexmedetomidine is quite limited. Discussion. There are several drugs with different pharmacological characteristics available for the performance of DISE. Knowledge of these properties and extensive experience is crucial for a safe and successful diagnosis.