0635 FEASIBILITY OF DRUG INDUCED SEDATION ENDOSCOPY IN THE BRONCHOSCOPY SUITE

Abstract

Patients with obstructive sleep apnea (OSA) commonly experience difficulty tolerating positive airway pressure (PAP) therapy. Drug Induced Sedation Endoscopy (DISE) assesses airway characteristics while the patient is sedated and may help guide alternative interventions for OSA. Since DISE is performed in the operating room, its cost is high and its availability limited to the surgeon’s busy schedule. Performing DISE in the bronchoscopy suite may reduce cost and improve access to care while maintaining a low risk for complications. Following training by an ENT physician, a sleep boarded pulmonologist performed DISE in the bronchoscopy suite. Patients with OSA and difficulty tolerating PAP therapy were evaluated for alternative interventions via DISE. A propofol infusion was administered by an anesthesiologist trained on performing DISE and sedation level was tracked via Bispectral IndexTM for a target level of 60–75. Videos of the DISE were recorded for multidisciplinary conference review with ENT and to track patient outcomes following interventions. Baseline polysomnography prior to DISE was reviewed to classify severity of OSA. Complication rates were tracked. Facility costs of DISE in the bronchoscopy suite were compared to those of the operating room. The sleep trained pulmonologist performed 21 DISE procedures in the bronchoscopy suite over a period of ten months. Review of polysomnography prior to DISE demonstrated an average AHI of 34.3+/-15.9 and an average SpO2 nadir 78 +/- 8.3%. No complications were observed during DISE. The facility fee for performing DISE procedures in the operating room was twice as much as the facility fee for performing DISE in the bronchoscopy suite while the operator charges were the same. Based on these findings, performance of DISE in the bronchoscopy suite appears feasible, safe and cost effective. Its performance by the sleep trained pulmonologist may improve access to care and may help identify successful alternative treatments for patients with PAP intolerance. Further studies are needed to identify the training necessary for pulmonary based sleep specialists to become proficient in the procedure. None