Drug Induced Sleep Endoscopy is Key Tool for Apnea Surgery


A study in Anesthesia & Analgesia (Safety and Efficacy of Drug-Induced Sleep Endoscopy Using a Probability Ramp Propofol Infusion System in Patients with Severe Obstructive Sleep Apnea) declares that Drug Induced Sleep Endoscopy (DISE) can help surgeons envision the mechanism of severe sleep apnea, which could be a significant aid prior to surgery.


Dr. Joshua H. Atkins and Dr. Jeff E. Mandel of the University of Pennsylvania and their colleagues have reportedly developed a new “ramp control” anesthetic technique for putting patients to sleep briefly—just enough to show the “obstructive anatomy” responsible for sleep apnea. The simplified technique requires no special expertise and limits drops in blood oxygen level during testing.


Researchers evaluated their anesthetic technique in 97 patients participating in a study of robot-assisted surgery for severe sleep apnea. Visualizing the site of the obstruction in the upper airway is an important part of planning for apnea surgery.


This can be done using a procedure called ‘drug-induced sleep endoscopy’ in which stepwise doses of anesthetic doses are given to put the patient to sleep and reproduce the airway obstruction causing apnea. However, it’s challenging to achieve just the right anesthetic dosage-enough to cause typical sleep-related obstruction without causing prolonged unconsciousness or causing a deep drop in blood oxygen level (oxygen saturation). The standard technique for DISE is time-consuming and not well-suited for widespread clinical use.


According to a report in News-Medical, the 97 patients studied had severe sleep apnea, with a median of 48 apnea-hypopnea events (complete or partial interruptions of breathing) per hour on standard testing in the sleep laboratory. The patients were being evaluated for surgery after receiving no benefit from continuous positive airway pressure (CPAP), the standard treatment for sleep apnea.


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