Lo Yu-Lun, Ni Yung-Lun, Wang Tsai-Yu, Lin Ting-Yu, Li Hsueh-Yu, White David P, Lin Jr-Rung, Kuo Han-Pin
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.
Healthcare Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
J Clin Sleep Med. 2015 Sep 15;11(9):1011-20. doi: 10.5664/jcsm.5016.
To evaluate the effect of sedation depth on drug-induced sleep endoscopy (DISE).
Ninety patients with obstructive sleep apnea (OSA) and 18 snorers underwent polysomnography and DISE under bispectral index (BIS)-guided propofol infusion at two different sedation levels: BIS 65-75 (light sedation) and 50-60 (deep sedation).
For the patients with OSA, the percentages of velopharynx, oropharynx, hypopharynx, and larynx obstructions under light sedation were 77.8%, 63.3%, 30%, and 33.3%, respectively. Sedation depth was associated with the severity of velopharynx and oropharynx obstruction, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse. In comparison, OSA severity was associated with the severity of velopharynx obstruction, severity of oropharynx obstruction, and arytenoid prolapse (odds ratio (95% confidence interval); 14.3 (4.7-43.4), 11.7 (4.2-32.9), and 13.2 (2.8-62.3), respectively). A good agreement was noted between similar DISE findings at different times and different observers (kappa value 0.6 to 1, respectively). A high percentage of arytenoid prolapse (46.7% among the patients with OSA under light sedation) was noted.
Greater sedative depth increased upper airway collapsibility under DISE assessment. DISE under BIS-guided propofol infusion, and especially a level of 65-75, offers an objective and reproducible method to evaluate upper airway collapsibility. Some findings were induced by drug sedation and need careful interpretation. Specific arytenoid prolapse patterns were noted for which further investigations are warranted.
http://www.clinicaltrials.gov, identifier: NCT01100554.
A commentary on this article appears in this issue on page 965.
评估镇静深度对药物诱导睡眠内镜检查（DISE）的影响。
90例阻塞性睡眠呼吸暂停（OSA）患者和18例打鼾者在脑电双频指数（BIS）引导下输注丙泊酚，于两种不同镇静水平：BIS 65 - 75（浅镇静）和50 - 60（深镇静）下接受多导睡眠图检查和DISE。
对于OSA患者，浅镇静下软腭咽、口咽、下咽和喉阻塞的百分比分别为77.8%、63.3%、30%和33.3%。镇静深度与软腭咽和口咽阻塞的严重程度、口咽阻塞模式、舌根阻塞、会厌前后脱垂和折叠以及杓状软骨脱垂有关。相比之下，OSA严重程度与软腭咽阻塞的严重程度、口咽阻塞的严重程度和杓状软骨脱垂有关（优势比（95%置信区间）；分别为14.3（4.7 - 43.4）、11.7（4.2 - 32.9）和13.2（2.8 - 62.3））。不同时间和不同观察者之间类似的DISE结果具有良好的一致性（kappa值分别为0.6至1）。观察到较高比例的杓状软骨脱垂（浅镇静下OSA患者中为46.7%）。
在DISE评估下，更深的镇静深度会增加上气道的可塌陷性。BIS引导下输注丙泊酚进行DISE，尤其是65 - 75的水平，提供了一种评估上气道可塌陷性的客观且可重复的方法。一些结果是由药物镇静诱导的，需要仔细解读。注意到特定的杓状软骨脱垂模式，对此值得进一步研究。
http://www.clinicaltrials.gov，标识符：NCT01100554。
关于本文的一篇评论发表在本期第965页。
