European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 1, pp 181–187

Drug-induced sleep endoscopy: a two drug comparison and simultaneous polysomnography

  • Marina Carrasco Llatas
  • Gabriela Agostini Porras
  • Maria Teresa Cuesta González
  • Adelaida Rodrigo Sanbartolomé
  • Pau Giner Bayarri
  • Fernando Gómez-Pajares
  • José Dalmau Galofre


The purpose of the present study was to compare pharyngeal and polysomnographical findings during drug-induced sleep endoscopy (DISE) performed with either propofol or midazolam as a single sedative agent. It is prospective, non-randomized, double-blinded case series study. Sixteen patients with sleep disordered breathing were sedated first with propofol and after full wake up with midazolam. Simultaneous polysomnography (PSG) was performed. We compared the zones of obstruction and vibration found with both drugs using the VOTE classification. Simultaneous PSG findings are also compared. There were 15 men and one woman; the mean age was 42.7 years old, mean body mass index 26.9 kg/m2. Average DISE duration was 20 min with Propofol and 14.3 min with Midazolam. The induced sleep stage obtained was N2 with both drugs. Outpatient physical exam did not correlate with drug-induced sleep findings. There was a good correlation between DISE results with both drugs in all the areas of collapse except the velum (p < 0.005). Using a continuous perfusion, there is a good agreement in the findings observed in DISE performed with propofol and midazolam and PSG.


Drug-induced sleep endoscopy Propofol Midazolam Sleep apnea Snoring PSG 


  1. 1.
    Young T, Finn L (1998) Epidemiological insights into the public health burden of sleep disordered breathing: sex differences in survival among sleep clinic patients. Thorax 53(Suppl 3):S16–S19PubMedCrossRefGoogle Scholar
  2. 2.
    Pieters T, Collard P, Aubert G, Dury M, Delguste P, Rodenstein DO (1996) Acceptance and long-term compliance with nCPAP in patients with obstructive sleep apnoea syndrome. Eur Respir J 9:939–944PubMedCrossRefGoogle Scholar
  3. 3.
    Richard W, Venker J, Den Herder C, Kox D, Van den Berg B, Laman M, Van Tinteren H, De Vries N (2007) Acceptance and long-term compliance of nCPAP in obstructive sleep apnea. Eur Arch Otorhinolaryngol 264:1081–1086PubMedCrossRefGoogle Scholar
  4. 4.
    Croft CB, Pringle M (1991) Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 16:504–509PubMedCrossRefGoogle Scholar
  5. 5.
    Vroegop AVMT, Vanderveken OM, Dieltjens M, Wouters K, Saldien V, Braem MJ, Van de Heyning PH (2012) Sleep endoscopy with simulation bite for prediction of oral appliance treatment outcome. J Sleep Res. doi:10.1111/jsr.12008 PubMedGoogle Scholar
  6. 6.
    Vanderveken OM, Vroegop AVMT, Van de Heyning PH, Braem MJ (2011) Drug-induced sleep endoscopy completed with a simulation bite approach for the prediction of the outcome of treatment of obstructive sleep apnea with mandibular repositioning appliances. Oper Tech Otolaryngol 22:175–182CrossRefGoogle Scholar
  7. 7.
    Roblin G, Williams AR, Whittet H (2001) Target-controlled infusion in sleep endoscopy. Laryngoscope 111:175–176PubMedCrossRefGoogle Scholar
  8. 8.
    Berry S, Roblin G, Williams A, Watkins A, Whittet HB (2005) Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope 115:538–540PubMedCrossRefGoogle Scholar
  9. 9.
    Abdullah VJ, Wing YK, Van Hasselt CA (2003) Video sleep nasendoscopy: the Hong Kong experience. Otolaryngol Clin North Am 36:461–471, viPubMedCrossRefGoogle Scholar
  10. 10.
    Kotecha BT, Hannan SA, Khalil HMB, Georgalas C, Bailey P (2007) Sleep nasendoscopy: a 10-year retrospective audit study. Eur Arch Otorhinolaryngol 264:1361–1367PubMedCrossRefGoogle Scholar
  11. 11.
    Babar-Craig H, Rajani NK, Bailey P, Kotecha BT (2012) Validation of sleep nasendoscopy for assessment of snoring with bispectral index monitoring. Eur Arch Otorhinolaryngol 269:1277–1279PubMedCrossRefGoogle Scholar
  12. 12.
    Lin AC, Koltai PJ (2012) Sleep endoscopy in the evaluation of pediatric obstructive sleep apnea. Int J Pediatr 2012:576719PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Ulualp SO, Szmuk P (2012) Drug-induced sleep endoscopy for upper airway evaluation in children with obstructive sleep apnea. Laryngoscope. doi:10.1002/lary.23832 PubMedGoogle Scholar
  14. 14.
    Steinhart H, Kuhn-Lohmann J, Gewalt K, Constantinidis J, Mertzlufft F, Iro H (2000) Upper airway collapsibility in habitual snorers and sleep apneics: evaluation with drug-induced sleep endoscopy. Acta Otolaryngol 120:990–994PubMedCrossRefGoogle Scholar
  15. 15.
    Rodriguez-Bruno K, Goldberg AN, McCulloch CE, Kezirian EJ (2009) Test-retest reliability of drug-induced sleep endoscopy. Otolaryngol Head Neck Surg 140:646–651PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Kezirian EJ, White DP, Malhotra A, Ma W, McCulloch CE, Goldberg AN (2010) Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 136:393–397PubMedCrossRefGoogle Scholar
  17. 17.
    Abdullah VJ, Lee DLY, Ha SCN, Van Hasselt CA (2012) Sleep endoscopy with midazolam: sedation level evaluation with bispectral analysis. Otolaryngol Head Neck Surg. doi:10.1177/0194599812464865 PubMedGoogle Scholar
  18. 18.
    Dalmau J, Carrasco Llatas M, Amorós LI, López C, Pla A, López Martínez R, López R, Viñoles J (2002) Video fiber endoscopy during induced sleep. Acta Otorrinolaringol Esp 53:502–504PubMedCrossRefGoogle Scholar
  19. 19.
    Carrasco Llatas M, Dalmau Galofre J, López Martínez R, Fernández Martínez S, Viñoles J, López R (2005) Our findings in the sleep endoscopy exams. Acta Otorrinolaringol Esp 56:17–21PubMedCrossRefGoogle Scholar
  20. 20.
    Kezirian EJ, Hohenhorst W, De Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268:1233–1236PubMedCrossRefGoogle Scholar
  21. 21.
    Rabelo FAW, Braga A, Küpper DS, De Oliveira JAA, Lopes FM, De Lima Mattos PLV, Barreto SG, Sander HH, Fernandes RMF, Valera FCP (2010) Propofol-induced sleep: polysomnographic evaluation of patients with obstructive sleep apnea and controls. Otolaryngol Head Neck Surg 142:218–224PubMedCrossRefGoogle Scholar
  22. 22.
    Genta PR, Eckert DJ, Gregorio MG, Danzi NJ, Moriya HT, Malhotra A, Lorenzi-Filho G (2011) Critical closing pressure during midazolam-induced sleep. J Appl Physiol 111:1315–1322PubMedCrossRefGoogle Scholar
  23. 23.
    De Vito A, Agnoletti V, Berrettini S, Piraccini E, Criscuolo A, Corso R, Campanini A, Gambale G, Vicini C (2011) Drug-induced sleep endoscopy: conventional versus target controlled infusion techniques—a randomized controlled study. Eur Arch Otorhinolaryngol 268:457–462PubMedCrossRefGoogle Scholar
  24. 24.
    Eichler C, Sommer JU, Stuck BA, Hörmann K, Maurer JT (2012) Does drug-induced sleep endoscopy change the treatment concept of patients with snoring and obstructive sleep apnea? Sleep Breath. doi:10.1007/s11325-012-0647-9 PubMedGoogle Scholar
  25. 25.
    Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR (2005) Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology 103:470–477PubMedCrossRefGoogle Scholar
  26. 26.
    Hillman DR, Walsh JH, Maddison KJ, Platt PR, Kirkness JP, Noffsinger WJ, Eastwood PR (2009) Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofol. Anesthesiology 111:63–71PubMedCrossRefGoogle Scholar
  27. 27.
    Hohenhorst W, Ravesloot MJL, Kezirian EJ, De Vries N (2012) Drug-induced sleep endoscopy in adults with sleep-disordered breathing: technique and the VOTE Classification system. Oper Tech Otolaryngol 23:11–18CrossRefGoogle Scholar
  28. 28.
    Propofol Official FDA information, side effects and uses. Accessed 27 Jan 2013
  29. 29.
    Murphy M, Bruno M-A, Riedner BA et al (2011) Propofol anesthesia and sleep: a high-density EEG study. Sleep 34:283–291APubMedGoogle Scholar
  30. 30.
    Hoshino Y, Ayuse T, Kurata S, Ayuse T, Schneider H, Kirkness JP, Patil SP, Schwartz AR, Oi K (2009) The compensatory responses to upper airway obstruction in normal subjects under propofol anesthesia. Respir Physiol Neurobiol 166:24–31PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Midazolam Injection Official FDA information, side effects and uses. Accessed 27 Jan 2013
  32. 32.
    Ayuse T, Inazawa T, Kurata S, Okayasu I, Sakamoto E, Oi K, Schneider H, Schwartz AR (2004) Mouth-opening increases upper-airway collapsibility without changing resistance during midazolam sedation. J Dent Res 83:718–722PubMedCrossRefGoogle Scholar
  33. 33.
    Ikeda H, Ayuse T, Oi K (2006) The effects of head and body positioning on upper airway collapsibility in normal subjects who received midazolam sedation. J Clin Anesth 18:185–193PubMedCrossRefGoogle Scholar
  34. 34.
    Inazawa T, Ayuse T, Kurata S, Okayasu I, Sakamoto E, Oi K, Schneider H, Schwartz AR (2005) Effect of mandibular position on upper airway collapsibility and resistance. J Dent Res 84:554–558PubMedCrossRefGoogle Scholar
  35. 35.
    Ravesloot MJL, De Vries N (2011) One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope 121:2710–2716PubMedCrossRefGoogle Scholar
  36. 36.
    George JR, Chung S, Nielsen I, Goldberg AN, Miller A, Kezirian EJ (2012) Comparison of drug-induced sleep endoscopy and lateral cephalometry in obstructive sleep apnea. Laryngoscope 122:2600–2605PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Gillespie MB, Reddy RP, White DR, Discolo CM, Overdyk FJ, Nguyen SA (2012) A trial of drug-induced sleep endoscopy in the surgical management of sleep-disordered breathing. Laryngoscope. doi:10.1002/lary.23506 Google Scholar
  38. 38.
    Hewitt RJD, Dasgupta A, Singh A, Dutta C, Kotecha BT (2009) Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction? Eur Arch Otorhinolaryngol 266:691–697PubMedCrossRefGoogle Scholar
  39. 39.
    Soares D, Folbe AJ, Yoo G, Badr MS, Rowley JA, Lin H-S (2013) Drug-induced sleep endoscopy vs awake Muller’s maneuver in the diagnosis of severe upper airway obstruction. Otolaryngol Head Neck Surg 148:151–156PubMedCrossRefGoogle Scholar
  40. 40.
    Campanini A, Canzi P, De Vito A, Dallan I, Montevecchi F, Vicini C (2010) Awake versus sleep endoscopy: personal experience in 250 OSAHS patients. Acta Otorhinolaryngol Ital 30:73–77PubMedCentralPubMedGoogle Scholar
  41. 41.
    Den Herder C, Van Tinteren H, De Vries N (2005) Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring. Laryngoscope 115:735–739CrossRefGoogle Scholar
  42. 42.
    Hessel NS, De Vries N (2003) Results of uvulopalatopharyngoplasty after diagnostic workup with polysomnography and sleep endoscopy: a report of 136 snoring patients. Eur Arch Otorhinolaryngol 260:91–95PubMedGoogle Scholar
  43. 43.
    Iwanaga K, Hasegawa K, Shibata N, Kawakatsu K, Akita Y, Suzuki K, Yagisawa M, Nishimura T (2003) Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep. Acta Otolaryngol Suppl 550:36–40Google Scholar
  44. 44.
    Camilleri AE, Ramamurthy L, Jones PH (1995) Sleep nasendoscopy: what benefit to the management of snorers? J Laryngol Otol 109:1163–1165PubMedCrossRefGoogle Scholar
  45. 45.
    Koutsourelakis I, Safiruddin F, Ravesloot M, Zakynthinos S, De Vries N (2012) Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome. Laryngoscope 122:2587–2591PubMedCrossRefGoogle Scholar
  46. 46.
    Soares D, Sinawe H, Folbe AJ, Yoo G, Badr S, Rowley JA, Lin H-S (2012) Lateral oropharyngeal wall and supraglottic airway collapse associated with failure in sleep apnea surgery. Laryngoscope 122:473–479PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Marina Carrasco Llatas
    • 1
    • 4
  • Gabriela Agostini Porras
    • 1
  • Maria Teresa Cuesta González
    • 1
  • Adelaida Rodrigo Sanbartolomé
    • 2
  • Pau Giner Bayarri
    • 2
  • Fernando Gómez-Pajares
    • 3
  • José Dalmau Galofre
    • 1
  1. 1.Department of Otolaryngology/Head and Neck SurgeryHospital Universitario Dr. PesetValenciaSpain
  2. 2.Department of NeurophysiologyHospital Universitario Dr. PesetValenciaSpain
  3. 3.Department of Preventive MedicineHospital Francesc de BorjaValenciaSpain
  4. 4.ValenciaSpain

Personalised recommendations