Drug-Induced Sleep Endoscopy with Target-Controlled Infusion Using Propofol in the Management of Patients with Obstructive Sleep Apnea

Abstract

Although it seems to be an exhausted subject at first glance, the therapeutic approach in obstructive sleep apnea syndrome (O.S.A.S.) is still an open subject. The continuous positive airway pressure (C.P.A.P.) represents the gold standard of therapy in O.S.A.S. However, this therapeutic process with C.P.A.P. has a low rate of compliancy, over 50% of patients quit in the first year of use. Implicitly, surgical solutions or mandibular advancement devices remain an alternative for many of these patients. High costs, complexity and risks associated with surgery have led to the identification of more accurate methods for topographic and functional diagnosis in O.S.A.S. Drug-induced sleep endoscopy (D.I.S.E.) with target-controlled infusion (T.C.I.) using propofol in the management of patients with obstructive sleep apnea is a relatively recently introduced method in Romania. The present paper describes our experience with D.I.S.E for selected patients, who have undergone surgery on the upper airway for O.S.A.S. The D.I.S.E method has led to the modification of the initial surgical plan in over 60% of patients with multi-level obstruction. Under these conditions, the surgical success rate in patients of the study increased to 80% at 6 months. Considering the specific endowment of each tertiary sleep center, the presence or absence of an operator block and the anesthetist�s experience with target-controlled (T.C.I.) infusion using propofol, more extensive and multicenter studies are needed for standardization of D.I.S.E.