DISE: A 2‐Drug Comparison and Simultaneous Polysomnography

Abstract

Objective: The aim of this study is to evaluate propofol and midazolam as sleep inducers in drug-induced sleep endoscopy, for the topographic diagnosis of upper airway obstruction during sleep; compare one to the other as well as with natural sleep polysomnography results. Method: Prospective series of 16 patients with suspected obstructive sleep apnea. Following physical examination and conventional polysomnography, sleep nasendoscopy along with simultaneous polysomnography was performed, obtaining apnea-hypopnea index, lowest oxygen saturation, apnea durations, and sleep cycle stages. The procedure was done with propofol and with midazolam. Results: There were 15 men and 1 woman; the mean age was 42.7 years old, mean body mass index 26.86. Average druginduced sleep endoscopy (DISE) duration was 20 minutes with propofol and 14.3 minutes with midazolam. The inducedsleep stage obtained was of phase 2. On 12 of the patients a whole-night polysomnography study was performed and compared with sleep nasendoscopy results. Physical exam did not correlate with drug-induced sleep findings. There was a good correlation between DISE results with both drugs (P < .001). The average apnea-hypopnea index was 16.38 for natural sleep, 28.63 for propofol, and 38.11 for midazolam. Conclusion: Obstruction areas are equivalent no matter which of the 2 mentioned sedatives are used. Although DISE is not entirely equivalent to an entire night sleep it can be considered comparable to most of the night sleep events.