Propofol-induced sleep: Polysomnographic evaluation of patients with obstructive sleep apnea and controls
Received 11 June 2009; received in revised form 28 October 2009; accepted 3 November 2009.
Abstract
Objective
The localization of upper airway obstruction in patients with obstructive sleep apnea (OSA) may optimize treatment. Nasoendoscopy during propofol sedation allows such an evaluation, but the effect of this drug on respiratory patterns and muscle relaxation is unknown. The objective of the present study was to determine through polysomnography whether propofol would change sleep parameters.
Study Design
Prospective study of subjects submitted to polysomnography under sedation with propofol.
Setting
Tertiary referral center.
Subjects and Methods
Fifteen non-obese subjects (4 controls/11 OSA patients) were submitted to two diurnal polysomnograms (90-120 minutes of sleep), with and without the use of propofol. The parameters presence of snoring, apnea-hypopnea index (AHI), oxygen desaturation, and sleep architecture were compared.
Results
The use of propofol did not induce snoring in the control subjects, whereas 100 percent of the OSA patients snored. AHI and mean oxygen saturation (SaO2) did not differ significantly between examinations with and without sedation. However, minimum SaO2 differed significantly (P < 0.05) with sedation, being lower during propofol sedation. Propofol also significantly changed the sleep architecture, with a significant increase in N3 sleep (P < 0.005) and total abolishment of rapid eye movement sleep (P < 0.0005) during propofol sedation.
Conclusions
These preliminary results allow us to infer that sedation with propofol changes sleep architecture but permits respiratory evaluation, because the main respiratory parameters evaluated in OSA are maintained. These preliminary results support the view that nasoendoscopy under propofol sedation is a promising examination for management of this disease.
aDiscipline of Otorhinolaryngology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
bDiscipline of Anesthesiology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
cDepartment of Neuroscience and Sciences of Behavior, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
Corresponding author: Fábio A. W. Rabelo, Av Bandeirantes, 3900 12° andar CEP 14049-900, Ribeirão Preto – SP, Brazil
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT