Ordones Alexandre Beraldo, Grad Gustavo Freitas, Cahali Michel Burihan, Lorenzi-Filho Geraldo, Sennes Luiz Ubirajara, Genta Pedro Rodrigues
Department of Otolaryngology, Universidade de São Paulo, São Paulo, Brazil.
Pulmonary Division, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil.
J Clin Sleep Med. 2020 May 15;16(5):725-732. doi: 10.5664/jcsm.8334. Epub 2020 Feb 7.
Drug-induced sleep endoscopy (DISE) using propofol is commonly used to identify the pharyngeal structure involved in collapse among patients with obstructive sleep apnea. DISE has never been compared with zolpidem-induced sleep endoscopy. We hypothesized that propofol at recommended sedation levels does not influence upper airway collapsibility nor the frequency of multilevel pharyngeal collapse as compared with zolpidem-induced sleep.
Twenty-one patients with obstructive sleep apnea underwent polysomnography and sleep endoscopy during zolpidem-induced sleep and during DISE with propofol. A propofol target-controlled infusion was titrated to achieve a bispectral index between 50 and 70. Airway collapsibility was estimated and compared in both conditions by peak inspiratory flow and the magnitude of negative effort dependence. Respiratory drive was estimated by the difference between end-expiratory and peak-negative inspiratory pharyngeal pressure (driving pressure). Site and configuration of pharyngeal collapse during zolpidem-induced sleep and DISE with propofol were compared.
The frequency of multilevel collapse during zolpidem-induced sleep was similar to that observed during DISE with propofol (72% vs 86%, respectively; difference: 14%; 95% confidence interval: -12% to 40%; P = .453). The endoscopic classification of pharyngeal collapse during both conditions were similar. Peak inspiratory flow, respiratory drive (effect size: 0.05 and 0.03, respectively), and negative effort dependence (difference: -6%; 95% confidence interval: -16% to 4%) were also similar in both procedures.
In this pilot study, recommended propofol doses did not significantly increase multilevel pharyngeal collapse or affect upper airway collapsibility and respiratory drive as compared with zolpidem-induced sleep.
Registry: clinicaltrials.gov; Name: Natural and Drug Sleep Endoscopy; URL: https://clinicaltrials.gov/ct2/show/study/NCT03004014; Identifier: NCT03004014.
使用丙泊酚的药物诱导睡眠内镜检查（DISE）常用于识别阻塞性睡眠呼吸暂停患者中参与塌陷的咽部结构。DISE从未与唑吡坦诱导的睡眠内镜检查进行过比较。我们假设，与唑吡坦诱导的睡眠相比，推荐镇静水平的丙泊酚不会影响上气道可塌陷性，也不会影响多级咽部塌陷的频率。
21例阻塞性睡眠呼吸暂停患者在唑吡坦诱导睡眠期间和丙泊酚DISE期间接受多导睡眠图和睡眠内镜检查。滴定丙泊酚靶控输注以实现脑电双频指数在50至70之间。通过吸气峰值流量和负努力依赖程度在两种情况下估计并比较气道可塌陷性。通过呼气末和吸气峰值负咽部压力之间的差异（驱动压力）估计呼吸驱动力。比较唑吡坦诱导睡眠期间和丙泊酚DISE期间咽部塌陷的部位和形态。
唑吡坦诱导睡眠期间的多级塌陷频率与丙泊酚DISE期间观察到的频率相似（分别为72%和86%；差异：14%；95%置信区间：-12%至40%；P = 0.453）。两种情况下咽部塌陷的内镜分类相似。两种检查中吸气峰值流量、呼吸驱动力（效应大小分别为0.05和0.03）以及负努力依赖程度（差异：-6%；95%置信区间：-16%至4%）也相似。
在这项初步研究中，与唑吡坦诱导的睡眠相比，推荐的丙泊酚剂量不会显著增加多级咽部塌陷，也不会影响上气道可塌陷性和呼吸驱动力。
注册机构：clinicaltrials.gov；名称：自然与药物睡眠内镜检查；网址：https://clinicaltrials.gov/ct2/show/study/NCT03004014；标识符：NCT03004014。
