Effects of Anesthetic Depth Using the Bispectral Index During Sleep Endoscopy With PAP Titration

Area of Science:

• Sleep Medicine
• Anesthesiology
• Otolaryngology

Background:

• Airway collapsibility during drug-induced sleep endoscopy (DISE) is influenced by anesthetic depth.
• Bispectral Index (BIS) monitoring quantifies anesthetic depth using EEG signals.

Purpose of the Study:

• To investigate the relationship between anesthetic depth and airway collapsibility during DISE with positive airway pressure (DISE-PAP).
• To assess changes in VOTE scores and pharyngeal opening pressure (PhOP) at light and deep sedation levels.

Main Methods:

• A prospective study involving 17 patients with OSA undergoing DISE-PAP.
• Anesthetic depth was monitored using BIS, with light sedation defined as BIS ≥ 55 and deep sedation as BIS < 55.
• PhOP was measured as the minimum positive airway pressure required to open the airway at both sedation levels.

Main Results:

• Pharyngeal opening pressure (PhOP) showed a significant negative correlation with BIS readings (rho = -0.45, p = 0.0328).
• Opening pressures for the velum and epiglottis also correlated with BIS levels (p < 0.05).
• VOTE classification did not significantly correlate with BIS levels (p = 0.189).

Conclusions:

• Anesthetic depth, as measured by BIS, correlates with airway resistance, assessed by PhOP.
• Positive airway pressure (PAP) is a valuable tool in DISE for immediate and titratable measurement of pharyngeal collapsibility.