Comparison of three sedation regimens for drug-induced sleep endoscopy

Drug-induced sleep endoscopy (DISE) allows for direct airway observation in patients with obstructive sleep apnea. This study compared the safety profiles and efficacies of three regimens for DISE. Sixty-six patients were randomly assigned to receive propofol alone (n = 22), a propofol-remifentanil combination (n = 22), or a dexmedetomidine-remifentanil combination (n = 22). Remifentanil was infused at a concentration of 1.5 ng center dot ml(-1) in the propofol-remifentanil and dexmedetomidine-remifentanil groups, whereas saline was infused in the propofol group. The propofol and propofol-remifentanil groups received propofol at a starting concentration of 1.0 mu g center dot ml(-1), then 0.1 mu g center dot ml(-1) increments at 5 min intervals. The dexmedetomidine-remifentanil group received 1.0 mu g center dot kg(-1) loading dose of dexmedetomidine for 10 min and then 0.2 mu g center dot kg(-1)center dot h(-1) increments at 5 min intervals. The incidence of oxygen desaturation was significantly higher in the propofol-remifentanil group compared with that of the dexmedetomidine-remifentanil group (77 vs. 45 %, respectively, P = 0.024). Even with a maximum dose of dexmedetomidine (1.4 mu g center dot kg(-1)center dot h(-1)), 50 % of the dexmedetomidine-remifentanil group did not reach sufficient sedation and required additional propofol. Cough reflex occurred in five patients of propofol group and in neither of the other groups (P = 0.004). The propofol-remifentanil combination was associated with a higher incidence of desaturation. The dexmedetomidine-remifentanil combination was associated with inadequate sedation in one half of the patients, even though it produced less respiratory depression. Addition of remifentanil reduced the cough reflex.