Patrick Kellner1,2, Beatrice Herzog3, Sebastian Plößl4, Christian Rohrmeier5, Thomas Kühnel5, Ramona Wanzek2, Stefan Plontke4, Michael Herzog6,7. 1. Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 16, 23538, Lübeck, Germany. 2. Department of Anesthesiology and Surgical Intensive Care, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Germany. 3. Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany. 4. Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany. 5. Department of Otorhinolaryngology, Head and Neck Surgery, Franz-Joseph-Strauß-Allee 11, 93053, Regensburg, Germany. 6. Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany. hno@ctk.de. 7. Department of Otorhinolaryngology Head and Neck Surgery, Carl-Thiem-Klinikum gGmbH, Carl-Thiem-Str. 111, 03048, Cottbus, Germany. hno@ctk.de.
Abstract
PURPOSE: Drug-induced sedation endoscopy (DISE) and simulated snoring (SimS) can locate the site of obstruction in patients with sleep-disordered breathing (SDB). There is clinical evidence for a change in collapsibility of the upper airway depending on the depth of sedation. So far, a dose-response relationship between sedation and collapsibility has not been demonstrated. METHODS: DISE and SimS were performed in 60 consecutive patients with SDB under monitoring of depth of sedation by BiSpectral Index® (BIS). Initially, SimS was conducted followed by DISE using bolus application of propofol. Sedation was performed up to a sedation level representing slow wave sleep (BIS = 40). The collapsibility of the upper airway was documented at decreasing sedation levels by an identical pictogram classification. RESULTS: For all levels and patterns of obstruction, a dose-dependent increase in the collapsibility of the upper airway was detected. A maximum collapsibility was achieved at sedation levels representing slow wave sleep. The collapsibility during SimS corresponded to light sleep stages and did not cover slow wave sleep. CONCLUSION: A dose-dependent change of patterns of obstructions can be observed during DISE under BIS monitoring indicating sedation depth. The obtained patterns of obstruction during DISE and SimS should thus be interpreted with regard to the sedation depth.
PURPOSE: Drug-induced sedation endoscopy (DISE) and simulated snoring (SimS) can locate the site of obstruction in patients with sleep-disordered breathing (SDB). There is clinical evidence for a change in collapsibility of the upper airway depending on the depth of sedation. So far, a dose-response relationship between sedation and collapsibility has not been demonstrated. METHODS: DISE and SimS were performed in 60 consecutive patients with SDB under monitoring of depth of sedation by BiSpectral Index® (BIS). Initially, SimS was conducted followed by DISE using bolus application of propofol. Sedation was performed up to a sedation level representing slow wave sleep (BIS = 40). The collapsibility of the upper airway was documented at decreasing sedation levels by an identical pictogram classification. RESULTS: For all levels and patterns of obstruction, a dose-dependent increase in the collapsibility of the upper airway was detected. A maximum collapsibility was achieved at sedation levels representing slow wave sleep. The collapsibility during SimS corresponded to light sleep stages and did not cover slow wave sleep. CONCLUSION: A dose-dependent change of patterns of obstructions can be observed during DISE under BIS monitoring indicating sedation depth. The obtained patterns of obstruction during DISE and SimS should thus be interpreted with regard to the sedation depth.
Authors: Bhik T Kotecha; S Alam Hannan; Hesham M B Khalil; Christos Georgalas; Paul Bailey Journal: Eur Arch Otorhinolaryngol Date: 2007-06-20 Impact factor: 2.503
Authors: Victor James Abdullah; Dennis Lip Yen Lee; Stanley Ching Nam Ha; Charles Andrew van Hasselt Journal: Otolaryngol Head Neck Surg Date: 2012-10-30 Impact factor: 3.497