Sedative Choice in Drug-Induced Sleep Endoscopy: A Neuropharmacology-Based Review

Objective: To examine the suitability of commonly used agents for drug-induced sleep endoscopy (DISE) based on agent-specific neuropharmacology. Data Sources: PubMed. Review Methods: A literature search of the PubMed database was performed on January 1, 2016. A two-layered search strategy was performed to identify relevant pharmacologic agents and articles related to neuropharmacology for these agents. The first search identified relevant pharmacologic agents; the second search examined agents with greater than five results from search 1, along with medical subject headings respiration, sleep, pharmacology, and/or [respective agent] (e.g., propofol). Articles not in English were excluded. Bibliographies of pertinent articles were hand-searched for additional articles. Results: Three agents were commonly identified from search 1: propofol, midazolam, and dexmedetomidine with 44, 13, and 6 results, respectively. Of note, 11 results utilized coinduction with midazolam and propofol. Search 2 for propofol, midazolam, and dexmedetomidine retrieved 219, 220, and 26 results, respectively. Eleven results for propofol, 4 for midazolam, and 9 for dexmedetomidine were found to be related to their neuropharmacology. Conclusion: The current review demonstrates relatively few investigations seeking to characterize the neuropharmacologic suitability of DISE agents. Compared to propofol and midazolam, dexmedetomidine's mechanism of action appears most likely to induce natural sleep pathways. Further study of its effect on upper airway collapsibility (critical closing pressure) and pharyngeal muscle tone (genioglossus electrode electromyography) are needed.