PDF(Pubmed)
Abstract：
Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing pathology with significant clinical consequences, including increased cardiovascular risk and cognitive decline. Continuous positive airway pressure (CPAP) is the gold-standard treatment, but alternative strategies are sometimes needed for patients intolerant to CPAP. Drug-induced sleep endoscopy (DISE) is a key diagnostic tool for assessing upper airway obstruction in OSA patients and subsequently tailoring a surgical approach, with sedation protocols playing a crucial role in its efficacy and results accuracy. This study aimed to investigate the effect of adding remifentanil to a propofol target-controlled infusion (TCI) regimen on the sedation parameters and procedural outcomes of DISE. Materials and Methods: The study was conducted at the Central University and Emergency Military Hospital \"Dr. Carol Davila\" and Ria Clinic in Bucharest between July 2021 and October 2023. Thirty-one patients were enrolled and randomised into two groups: a propofol group (P group, n= 11) and a remifentanil-propofol group (R-P group, n = 20). DISE was performed using standardised protocols, sedative drugs were administered in TCI mode, and data on sedation levels, respiratory and cardiovascular parameters, and procedural incidents were collected. Results: The addition of remifentanil at 1 ng/mL effect-site concentration significantly reduced the effect-site concentration of propofol required for adequate sedation (3.4 ± 0.7 µg/mL in the P group vs. 2.8 ± 0.6 µg/mL in the R-P group, p = 0.035). The time to achieve adequate sedation was also shorter in the R-P group (7.1 ± 2.5 min vs. 9.5 ± 2.7 min, p = 0.017). The incidence of cough, hypoxemia, and cardiovascular events did not significantly differ between the two groups. Conclusions: Adding remifentanil to a propofol TCI regimen for DISE effectively reduces the required propofol effect-site concentration and shortens sedation time without increasing the risk of adverse events. This combination may enhance the safety and efficiency of DISE, offering a promising alternative for patients undergoing this procedure.
摘要：
背景和目的：阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠呼吸紊乱病理，具有显著的临床后果。包括心血管风险增加和认知能力下降。持续气道正压通气(CPAP)是治疗的金标准,但对于不耐受CPAP的患者,有时需要采取替代策略.药物诱导睡眠内窥镜检查（DISE）是评估OSA患者上呼吸道阻塞并随后定制手术方法的关键诊断工具。镇静方案在其疗效和结果准确性中起着至关重要的作用。本研究旨在探讨在丙泊酚靶控输注（TCI）方案中添加瑞芬太尼对DISE镇静参数和手术结局的影响。材料和方法：该研究于2021年7月至2023年10月在布加勒斯特的中央大学和紧急军事医院“CarolDavila博士”和Ria诊所进行。31例患者被纳入并随机分为两组：丙泊酚组（P组，n=11）和瑞芬太尼-丙泊酚组（R-P组，n=20）。DISE使用标准化方案进行，镇静药物以TCI模式给药，和镇静水平的数据，呼吸和心血管参数，并收集了程序性事件。结果：在1ng/mL效应点浓度下添加瑞芬太尼显着降低了足够镇静所需的异丙酚的效应点浓度（P组的3.4±0.7µg/mL与R-P组2.8±0.6µg/mL，p=0.035)。R-P组达到足够镇静的时间也较短（7.1±2.5分钟vs.9.5±2.7min,p=0.017)。咳嗽的发生率，低氧血症,两组间心血管事件无显著差异.结论：在DISE的异丙酚TCI方案中加入瑞芬太尼可有效降低所需的异丙酚效应点浓度，并缩短镇静时间，而不会增加不良事件的风险。这种组合可以提高DISE的安全性和效率，为接受这种手术的患者提供了一个有希望的替代方案。
