Propofol versus dexmedetomidine during drug-induced sleep endoscopy (DISE) for pediatric obstructive sleep apnea
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Propofol versus dexmedetomidine during drug-induced sleep endoscopy (DISE) for pediatric obstructive sleep apnea Erin M. Kirkham 1 & Karen Hoi 2 & Jonathan B. Melendez 2 & Lauren M. Henderson 2 & Aleda M. Leis 3 & Michael P. Puglia II 3 & Ronald D. Chervin 4 Received: 30 April 2020 / Revised: 17 August 2020 / Accepted: 21 August 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose To test for differences in DISE findings in children sedated with propofol versus dexmedetomidine. We hypothesized that the frequency of ≥ 50% obstruction would be higher for the propofol than dexmedetomidine group at the dynamic levels of the airway (velum, lateral walls, tongue base, and supraglottis) but not at the more static adenoid level. Methods A single-center retrospective review was performed on children age 1–18 years with a diagnosis of sleep disordered breathing or obstructive sleep apnea (OSA) who underwent DISE from July 2014 to Feb 2019 scored by the Chan-Parikh scale sedated with either propofol or dexmedetomidine (with or without ketamine). Logistic regression was used to test for a difference in the odds of ≥ 50% obstruction (Chan-Parikh score ≥ 2) at each airway level with the use of dexmedetomidine vs. propofol, adjusted for age, sex, previous tonsillectomy, surgeon, positional OSA, and ketamine co-administration. Results Of 117 subjects, 57% were sedated with propofol and 43% with dexmedetomidine. Subjects were 60% male, 66% Caucasian, 31% obese, 38% syndromic, and on average 6.5 years old. Thirty-three percent had severe OSA and 41% had previous tonsillectomy. There was no statistically significant difference in the odds of ≥ 50% obstruction between the two anesthetic groups at any level of the airway with or without adjustment for potential confounders. Conclusion We did not find a significant difference in the degree of upper airway obstruction on DISE in children sedated with propofol versus dexmedetomidine. Prospective, randomized studies would be an important next step to confirm these findings. Keywords Sleep endoscopy . DISE . Pediatric . Sleep apnea . Propofol . Dexmedetomidine
Introduction Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse that interrupts gas exchange and disrupts sleep [1]. Adenotonsillar hypertrophy is the main
* Erin M. Kirkham [email protected] 1
Department of Otolaryngology: Head & Neck Surgery, Mott Children’s Hospital, University of Michigan Medical Center, 1540 E. Hospital Dr. CW 5-702, SPC 4241, Ann Arbor, MI 48109, USA
2
University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
3
Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
4
Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
anatomic cause of sleep-related upper airway obstruction in children [2]. Thus, adenotonsillectomy (AT) remains the firstline treatment for pediatric
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