Sleep and Breathing

, Volume 21, Issue 3, pp 737–744 | Cite as

Drug-induced sleep endoscopy with target-controlled infusion using propofol and monitored depth of sedation to determine treatment strategies in obstructive sleep apnea

  • Clemens Heiser
  • Phillippe Fthenakis
  • Alexander Hapfelmeier
  • Sebastian Berger
  • Benedikt Hofauer
  • Winfried Hohenhorst
  • Eberhard F. Kochs
  • Klaus J. Wagner
  • Guenther M. Edenharter
ENT • Original Article



Drug-induced sleep endoscopy (DISE) has become an important diagnostic examination tool in the treatment decision process for surgical therapies in the treatment of obstructive sleep apnea (OSA). Currently, there is a variety of regimes for the performance of DISE, which renders comparison and assessment across results difficult. It remains unclear how the different regimes influence the findings of the examination and the resulting conclusions and treatment recommendations. This study aimed to investigate the correlation between increasing levels of sedation (i.e., light, medium, and deep) induced by propofol using a target-controlled infusion (TCI) pump, with the obstruction patterns at the levels of the velum, oropharynx, tongue base, and epiglottis (i.e., VOTE classification). A second goal was the establishment of a sufficient sedation level to enable a reliable decision regarding treatment recommendations.

Material and methods

Forty-three patients with OSA underwent a DISE procedure using propofol TCI. Three levels of sedation were defined, depending on entropy levels and assessment of sedation: light sedation, medium sedation, and deep sedation. The evaluation of the upper airway at each level, with increasing sedation, was documented using the VOTE classification. The elapsed time at which each assessment was performed was recorded.


Upper airway changes occurred and were measured throughout the DISE procedure. Clinically useful determinations of airway closure occurred at medium sedation; this level of sedation was most probably achieved with a blood propofol concentration of 3.2 μg/ml. In all 43 patients, definite treatment decisions could be made at medium sedation level. Increasing sedation did not result in changes in the treatment decision.


Changes in upper airway collapse during DISE with propofol TCI occur at levels of medium sedation. Decisions regarding surgical treatment could be made at this level of sedation.

Clinical trial name

Upper Airway Collapse in Patients with Obstructive Sleep Apnea Syndrome by Drug Induced Sleep Endoscopy (URL:

Registration number



Obstructive sleep apnea OSAS Anesthesia Sedation Drug-induced sleep endoscopy procedure DISE 


Compliance with ethical standards

Conflict of interest

Clemens Heiser is a consultant of Inspire Medical Systems (Maple Grove USA) and Sutter Medizintechnik GmbH (Freiburg, Germany). He received personal fees from Neuwirth Medical Products (Obernburg, Germany) and Heinen und Lösenstein (Bad Ems, Germany). Benedikt Hofauer received grants and research support from Inspire Medical Systems (Maple Grove USA).

Eberhard F. Kochs received grants and research support from the Federal Ministry of Educations and Research (Bonn, Germany) and German Research Foundation (Bonn, Germany).

Guenther M. Edenharter is a consultant of AbbVie GmbH & Co.KG (Wiesbaden, Germany).

Alexander Hapfelmeir, Phillippe Fthenakis, Sebastian Berger, Winfried Hohenhorst, and Klaus J. Wagner declare that they have no conflict of interests.

The article submitted is not related to any of these relationships.

Financial support

No financial support for this trial


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Clemens Heiser
    • 1
  • Phillippe Fthenakis
    • 2
  • Alexander Hapfelmeier
    • 3
  • Sebastian Berger
    • 2
  • Benedikt Hofauer
    • 1
  • Winfried Hohenhorst
    • 4
  • Eberhard F. Kochs
    • 2
  • Klaus J. Wagner
    • 2
  • Guenther M. Edenharter
    • 2
  1. 1.Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.Department of Anesthesiology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  3. 3.Institute of Medical Statistics and EpidemiologyTechnische Universität MünchenMunichGermany
  4. 4.Department of Otorhinolaryngology, Head and Neck SurgeryAlfried-Krupp-KrankenhausEssenGermany

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