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J Clin Sleep Med. 2020 Feb 7. doi: 10.5664/jcsm.8334. [Epub ahead of print]

Comparison of Upper Airway Obstruction During Zolpidem-Induced Sleep and Propofol-Induced Sleep in Patients With Obstructive Sleep Apnea: A Pilot Study.

Author information

1
Department of Otolaryngology, Universidade de São Paulo, São Paulo, Brazil.
2
Pulmonary Division, Heart Institute (InCor), Universidade de São Paulo, São Paulo, Brazil.

Abstract

STUDY OBJECTIVES:

Drug-induced sleep endoscopy (DISE) using propofol is commonly used to identify the pharyngeal structure involved in collapse among obstructive sleep apnea (OSA) patients. DISE has never been compared to 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 to zolpidem-induced sleep.

METHODS:

Twenty-one OSA patients 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 50-70. Airway collapsibility was estimated and compared in both conditions by peak inspiratory flow and the magnitude of negative effort dependence (NED). 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.

RESULTS:

The frequency of multilevel collapse during zolpidem-induced sleep was similar to the observed during DISE with propofol (72% vs 86%, respectively, difference [95% CI] 14% [-12 to 40%], p=0.453). 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 NED (difference [95% CI] -6% [-16 to 4%]) were also similar in both procedures.

CONCLUSION:

In this pilot study, recommended propofol doses did not significantly increase multilevel pharyngeal collapse or affect upper airway collapsibility and respiratory drive as compared to zolpidem-induced sleep.

KEYWORDS:

airway obstruction; endoscopy; obstructive sleep apnea; propofol

PMID:
32029070
DOI:
10.5664/jcsm.8334

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