• Yu-Lun Lo, Yung-Lun Ni, Tsai-Yu Wang, Ting-Yu Lin, Hsueh-Yu Li, David P White, Jr-Rung Lin, and Han-Pin Kuo.
• Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan.
• J Clin Sleep Med. 2015 Sep 15; 11 (9): 1011-20.

ObjectiveTo evaluate the effect of sedation depth on drug-induced sleep endoscopy (DISE).MethodsNinety patients with obstructive sleep apnea (OSA) and 18 snorers underwent polysomnography and DISE under bispectral index (BIS)-guided propofol infusion at two different sedation levels: BIS 65-75 (light sedation) and 50-60 (deep sedation).ResultsFor the patients with OSA, the percentages of velopharynx, oropharynx, hypopharynx, and larynx obstructions under light sedation were 77.8%, 63.3%, 30%, and 33.3%, respectively. Sedation depth was associated with the severity of velopharynx and oropharynx obstruction, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse. In comparison, OSA severity was associated with the severity of velopharynx obstruction, severity of oropharynx obstruction, and arytenoid prolapse (odds ratio (95% confidence interval); 14.3 (4.7-43.4), 11.7 (4.2-32.9), and 13.2 (2.8-62.3), respectively). A good agreement was noted between similar DISE findings at different times and different observers (kappa value 0.6 to 1, respectively). A high percentage of arytenoid prolapse (46.7% among the patients with OSA under light sedation) was noted.ConclusionsGreater sedative depth increased upper airway collapsibility under DISE assessment. DISE under BIS-guided propofol infusion, and especially a level of 65-75, offers an objective and reproducible method to evaluate upper airway collapsibility. Some findings were induced by drug sedation and need careful interpretation. Specific arytenoid prolapse patterns were noted for which further investigations are warranted.Clinical Trials Registrationhttp://www.clinicaltrials.gov, identifier: NCT01100554.CommentaryA commentary on this article appears in this issue on page 965.© 2015 American Academy of Sleep Medicine.

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