Bispectral index in evaluating effects of sedation depth on drug-induced sleep endoscopy

Yu Lun Lo, Yung Lun Ni, Tsai Yu Wang, Ting Yu Lin, Hsueh Yu Li, David P. White, Jr Rung Lin, Han Pin Kuo

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)


Objective: To evaluate the effect of sedation depth on druginduced sleep endoscopy (DISE). Methods: Ninety 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). Results: For 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% confi dence 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 fi ndings 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. Conclusions: Greater 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 fi ndings were induced by drug sedation and need careful interpretation. Specifi c arytenoid prolapse patterns were noted for which further investigations are warranted.

Original languageEnglish
Pages (from-to)1011-1020
Number of pages10
JournalJournal of Clinical Sleep Medicine
Issue number9
Publication statusPublished - Jan 1 2015
Externally publishedYes


  • Bispectral index
  • Drug-induced sleep endoscopy
  • Laryngeal obstruction
  • Obstructive sleep apnea

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


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