Anesthesia Techniques and Safety Considerations for Drug-Induced Sleep Endoscopy in Obstructive Sleep Apnea Patients: A Comprehensive Study

Dr Sunit Saxena ( MD (Anaesthesiology), HOD Anaesthesia and OT, Manipal Hospital, Jaipur), Dr Bhavya Sinha ( 3rd Year PG, DNB Anaesthesia)

Year: 2024, Volume: 1, Issue: 3, Page 188- 196, Date of Publication: 30 November 2024;

Abstract: Introduction- Sleep endoscopy, also known as drug-induced sleep endoscopy (DISE), is a diagnostic tool for evaluating upper airway obstruction in patients with obstructive sleep apnea (OSA). Anesthesia is pivotal in achieving a controlled sedative state that mimics natural sleep, ensuring patient safety and effective visualization of the airway dynamics. This comprehensive study reviews anesthesia techniques and safety considerations for DISE, focusing on optimizing patient outcomes. Methods- The study was conducted over one year with 100 patients clinically diagnosed with OSA. Exclusions included patients with neurological conditions, severe cardiac issues, and active nasal infections. Pre-procedure assessments included pre-anesthesia evaluations, blood tests, and imaging. Anesthesia was administered using Propofol titration, employing the Schneider model to achieve a snoring-apnea cycle. Standardized protocols were followed for patient positioning, monitoring, and sedation depth. Results- Propofol, administered in titrated doses, facilitated a controlled sedative state in all cases, allowing effective visualization of airway collapse. Moderate sedation was achieved in most patients, with minimal adverse events. Complications such as airway obstruction and respiratory depression were rare and managed promptly with established protocols. Discussion- The study highlights the role of anesthetic agents such as Propofol in achieving optimal sedation for DISE, ensuring airway patency and accurate diagnostic outcomes. Key considerations for anesthesiologists include precise drug titration, comprehensive patient monitoring, and readiness to manage potential complications like hypoxemia or aspiration. Conclusion- Anesthesia for sleep endoscopy is critical for the safety and success of the procedure. Adhering to evidence-based sedation protocols, tailored to individual patient profiles, enhances the diagnostic utility of DISE while minimizing risks. This study underscores the importance of anesthetic expertise in managing OSA through sleep endoscopy.

Keywords: Sleep endoscopy, Obstructive sleep apnea, Drug-induced sleep endoscopy, Anesthesia, Propofol, Airway management, Sedation protocols.