Controversial Aspects in Sedative Techniques for Drug-Induced Sleep Endoscopy (DISE)-A Narrative Review

Area of Science:

• Sleep Medicine
• Anesthesiology
• Otolaryngology

Background:

• Drug-induced sleep endoscopy (DISE) is crucial for diagnosing obstructive sleep apnea (OSA) by visualizing airway collapse.
• Current sedation protocols for DISE lack standardization, leading to variable clinical outcomes.
• Optimal sedation is essential to accurately assess airway dynamics without inducing artifactual collapse.

Purpose of the Study:

• To review and clarify current sedation strategies for DISE in OSA patients.
• To discuss the clinical implications of different sedative agents and techniques.
• To identify areas for future research and protocol development.

Main Methods:

• Systematic literature search of major databases (PubMed, Scopus, Web of Science, Cochrane Library) from 2000-2025.
• Inclusion of clinical studies, guidelines, and reviews on DISE sedation.
• Qualitative synthesis of data due to study heterogeneity.

Main Results:

• Propofol, dexmedetomidine, and midazolam are common agents, each with distinct effects on sedation and airway collapsibility.
• Dexmedetomidine offers a natural sleep state with less respiratory depression compared to propofol or midazolam.
• Target-controlled infusion and PK-PD modeling enhance propofol sedation control; co-sedatives increase risks.
• Lowest effective dose titration, often with Bispectral Index (BIS) monitoring, is recommended to avoid artifactual collapse.

Conclusions:

• Achieving optimal DISE sedation requires balancing depth of sedation with patient safety for reliable diagnostic findings.
• Minimizing sedative dose and utilizing objective monitoring like BIS are recommended practices.
• Standardized protocols and further research, particularly in obese OSA patients, are necessary to improve DISE utility.