The Use of Propofol versus Dexmedetomidine for Patients Receiving Drug-Induced Sleep Endoscopy: A Meta-Analysis of Randomized Controlled Trials.

Yi-Ting Chen,Min-Hsien Chiang,Cheuk-Kwan Sun,Shu-Wei Liao,Kuo-Chuan Hung,Kuan-Yu Wu,I-Wen Chen,Ying-Jen Chang

doi:10.3390/jcm10081585

Abstract

The sedation outcomes associated with dexmedetomidine compared with those of propofol during drug-induced sleep endoscopy (DISE) remains unclear. Electronic databases (i.e., the Cochrane controlled trials register, Embase, Medline, and Scopus) were searched from inception to 25 December 2020 for randomized controlled trials (RCTs) that evaluated the sedation outcomes with dexmedetomidine or propofol in adult patients diagnosed with obstructive sleep apnea (OSA) receiving DISE. The primary outcome was the difference in minimum oxygen saturation (mSaO2). Five RCTs (270 participants) published between 2015 and 2020 were included for analysis. Compared with dexmedetomidine, propofol was associated with lower levels of mSaO2 (mean difference (MD) = −7.24, 95% confidence interval (CI) −12.04 to −2.44; 230 participants) and satisfaction among endoscopic performers (standardized MD = −2.43, 95% CI −3.61 to −1.26; 128 participants) as well as a higher risk of hypoxemia (relative ratios = 1.82, 95% CI 1.2 to 2.76; 82 participants). However, propofol provided a shorter time to fall asleep and a lower risk of failed sedation compared with dexmedetomidine. No significant difference was found in other outcomes. Compared with propofol, dexmedetomidine exhibited fewer adverse effects on respiratory function and provided a higher level of satisfaction among endoscopic performers but was associated with an elevated risk of failed sedation.

Highlights

Obstructive sleep apnea (OSA), which is characterized by repeated complete or partial upper airway collapse, is an increasingly common sleep disorder, leading to cyclical hypoxemia and disrupted sleep
Drug-induced sleep endoscopy (DISE), which was introduced in 1991 [10], is considered to be a safe and practical technique to evaluate the location of dynamic upper airway collapse during sleep [12]
The databases of the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, and Scopus were searched for randomized controlled trials (RCTs) using the following keywords: “DISE”, “sleep endoscopy”, “drug-induced sleep endoscopy”, “Propofol”, “Diprivan”, “2, 6-diisopropylphenol”, “Dexmedetomidine”, “precedex”, “Dexdor”, and “RCT” from inception to 25 December 2020

Summary

Introduction

Obstructive sleep apnea (OSA), which is characterized by repeated complete or partial upper airway collapse, is an increasingly common sleep disorder, leading to cyclical hypoxemia and disrupted sleep. A previous study has demonstrated that patients with OSA had certain anatomical anomalies including a longer mandibular plane–hyoid distance, a smaller posterior airway space area, and a larger tongue volume compared with those in individuals without OSA [1]. Another study has attributed the blockade of air flow to a high collapsibility of the upper airway (i.e., a high passive critical closing pressure, Pcrit) [2]. Treatments of choice for OSA include continuous positive airway pressure (CPAP) [3], weight loss, oral appliances (e.g., mandibular advancement devices) [4,5], and surgical interventions [6,7]. Drug-induced sleep endoscopy (DISE), which was introduced in 1991 [10], is considered to be a safe and practical technique to evaluate the location of dynamic upper airway collapse during sleep [12]

Methods

Results

Discussion

Conclusion