Comparison of upper airway patency in patients with mild obstructive sleep apnea during dexmedetomidine or propofol sedation: a prospective, randomized, controlled trial

Hyun-Jung Shin, Eun-Young Kim, Jung-Won Hwang, Sang-Hwan Do, Hyo-Seok Na, Hyun-Jung Shin, Eun-Young Kim, Jung-Won Hwang, Sang-Hwan Do, Hyo-Seok Na

Abstract

Background: In addition to propofol, dexmedetomidine is a suitable alternative for intraoperative sedation in procedures requiring regional anesthesia. To date, however, little is known about the influences of each drug on upper airway patency. Accordingly, the authors investigated differences between dexmedetomidine and propofol sedation in the occurrence of upper airway obstruction and requirements for airway intervention in patients with mild obstructive sleep apnea.

Methods: Patients with an apnea/hypopnea index of 5-14/h according to Watch-PAT 200 analysis were enrolled in this study. Spinal anesthesia was routinely performed for surgery. Intraoperative sedation was initiated using either dexmedetomidine or propofol infusion at a level of modified observer's assessment of alertness/sedation scale 3. The primary outcome was the proportion of patients exhibiting signs of upper airway obstruction. A sign of upper airway obstruction was defined as no detection of end-tidal carbon dioxide for at least 10 s despite respiratory efforts.

Results: A total of 50 patients were included in the final analysis (dexmedetomidine [n = 26]; propofol [n = 24]). During the intraoperative sedation period, there was a significantly lower proportion of patients exhibiting signs of upper airway obstruction in the dexmedetomidine group than in the propofol group (11.5% vs. 41.7%, P = 0.035). An artificial airway was inserted in 1 patients (3.8%) and 5 patient (20.8%) in the dexmedetomidine and propofol groups, respectively (P = 0.093).

Conclusion: Dexmedetomidine sedation was associated with a lower incidence of upper airway obstruction than propofol sedation in patients with mild obstructive sleep apnea.

Trial registration number: Clinical trials.gov ( NCT02993718 ): Retrospectively registered.

Keywords: Dexmedetomidine; Obstructive sleep apnea; Propofol; Sedation.

Conflict of interest statement

Ethics approval and consent to participate

This study was performed according to the Declaration of Helsinki after the approval of Institutional Review Board of Seoul National University Bundang Hospital (B-1411/275–003). Written informed consent was obtained from the enrolled patients before surgery.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of patients’ enrollment. AHI, apnea/hypopnea index; BMI, body mass index
Fig. 2
Fig. 2
The change of modified Observer’s Assessment of Alertness/Sedation (OAA/S) scale. A stable mid-modified OAA/S scales were presented at 30 min intervals. PACU, post-anesthetic care unit
Fig. 3
Fig. 3
Changed of mean arterial pressure and heart rate during sedation and postoperative period, PACU, post-anesthetic care unit

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