Drug-induced sleep endoscopy in obstructive sleep apnea: a systematic review and meta-analysis of sedative agents,...

Drug-induced sleep endoscopy (DISE) enables direct visualization of upper airway collapse patterns in obstructive sleep apnea (OSA) patients, but inconsistencies in sedative selection, monitoring methods, and administration techniques may affect result reproducibility. This meta-analysis evaluates how these factors influence complete collapse rates according to VOTE classification.

Systematic searches of PubMed, Embase, and Cochrane Library identified studies performing DISE in OSA patients using single sedative agents (propofol, dexmedetomidine, or midazolam) with VOTE classification outcomes. Pooled collapse rates were estimated using generalized linear mixed models (GLMMs) with logit transformation. Univariate and multivariate metaregression analyses explored associations between sedative type, bispectral index (BIS) monitoring, drug administration method, body mass index (BMI), and collapse patterns.

Twenty-two studies involving 3478 patients were included. Pooled complete collapse rates were velum 73.7% (95% CI 66.3-80.0), tongue base 40.6% (32.3-49.5), oropharynx 30.6% (24.6-38.4), and epiglottis 24.7% (17.3-34.0). Sedative type showed no significant association with collapse rates at any site (all PQM > 0.05). BIS monitoring was independently associated with reduced tongue base collapse (coefficient =  - 1.39, p = 0.002), while BMI significantly predicted velum collapse (coefficient = 0.40, p < 0.001). Continuous infusion showed borderline significance at the oropharynx (P_QM = 0.059). Significant publication bias at the epiglottis adjusted collapse rates from 24.7 to 47%; however, this adjustment may reflect definitional heterogeneity.

DISE outcomes are more influenced by sedation depth monitoring and patient anatomy than sedative choice. BIS monitoring should be prioritized for tongue base assessment, while BMI-driven velum collapse reflects anatomical factors. Standardized protocols emphasizing objective monitoring may enhance DISE reliability.