A Comparative Study on Efficacy and Safety of Propofol versus Dexmedetomidine in Sleep Apnea Patients undergoing Drug-Induced Sleep Endoscopy: A CONSORT-Prospective, Randomized, Controlled Clinical Trial.

L L Zhao,Y Han,J P Yang,J Q Wei,L Han,H Liu,Y Y Zhang

doi:10.1155/2018/8696510

Abstract

The aim of this study is to compare the efficacy and safety of propofol with dexmedetomidine in patients with obstructive sleep apnea hypopnea syndrome (SAHS) undergoing drug-induced sleep endoscopy (DISE). The 88 patients diagnosed with SAHS in the Affiliated Hospital of Xuzhou Medical University were randomly allocated into 2 groups (n = 44). Patients in the group dexmedetomidine (group D) received continuous intravenous infusion of dexmedetomidine 1 μg/kg over 15 minutes before the endoscopy, and propofol 2 mg/kg was intravenously administrated in the group propofol (group P). Cardiopulmonary parameters of patients were recorded. The time to fall asleep, duration of endoscopic examination, the wakeup time of patients, the number of mask ventilations for patients, the satisfaction of patients and endoscopic performers, and false positive cases of SAHS of patients were compared between the two groups. Compared with group D, mean arterial pressure (MAP) and blood oxygen saturation (SPO2) of patients in the P group were lower at the time point of T1 (P < 0.05), the duration of endoscopic examination and wakeup time of patients were obviously prolonged, the incidence of mask ventilation for patients and false positive cases of SAHS of patients was observably higher, and the satisfaction of endoscopic performers was markedly lower, but the time to fall asleep was significantly shortened (P < 0.05). Dexmedetomidine served as a novel sleep induced drug and can provide satisfactory conditions and be safely and effectively applied for endoscopy in patients with SAHS, without adverse hemodynamic effects.

Highlights

Patients with sleep apnea hypopnea syndrome (SAHS) have episodes of apnea or hypopnea due to the obstructive upper airways
The sleep induced by all of these drugs used in the clinic for drug-induced sleep endoscopy (DISE) is not in accordance with the natural physiological sleep, which interferes with the dynamic anatomical changes of airway causing apnea in the patients with SAHS
There was no significant difference between the two groups in demographic data (age: 42.5 ± 6.0 in group dexmedetomidine (group D) vs 43.2 ± 6.6 in group propofol (group P); sex: 42/2 in group D vs 40/4 in group P), body mass index (BMI) (28.0 ± 3.5 in group D vs 28.9 ± 3.1 in group P), apnea hypopnea index (AHI) (56.3 ± 21.5 in group D vs 54.3 ± 20.4 in group P), and Lowest oxygen saturation mean arterial pressure (MAP) (LSaO2)

Summary

Introduction

Patients with SAHS have episodes of apnea or hypopnea due to the obstructive upper airways. DISE can be used to observe the obstructive position and the anatomical factors causing local obstruction in the patients with SAHS under the condition of “sleep” and provide an important evidence for the reconstruction of the upper airway in these patients. A great number of studies have reported the validity and reliability of DISE. Studies showed that the target-controlled infusion of propofol can accurately control the depth of sedation during DISE, the ventilatory response to hypoxic can be depressed by larger doses of propofol during conscious sedation [3]. The sleep induced by all of these drugs used in the clinic for DISE is not in accordance with the natural physiological sleep, which interferes with the dynamic anatomical changes of airway causing apnea in the patients with SAHS

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