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Objectives/hypothesis: The treatment for obstructive sleep apnea syndrome (OSAS) depends on correct localization of upper airway obstruction, exception made for continuous positive airway pressure (CPAP). Drug-induced sleep endoscopy (DISE) with propofol allows this evaluation, but the drug effects on sleep parameters are not yet well established. Our objective was to study by polysomnography (PSG) whether propofol would change sleep parameters by means of a prospective cross-sectional clinical study in a tertiary hospital., Study Design: Thirty non-obese subjects (6 controls and 24 OSAS patients) underwent two daytime PSGs, one with DISE and the other without DISE., Methods: During DISE exam, propofol was administered intravenously in continuous infusion using a target-controlled infusion pump. The parameters evaluated were: presence of snoring, apnea-hypopnea index (AHI), oxyhemoglobin saturation (SaO2), and sleep macroarchitecture., Results: Snoring was absent in all healthy subjects during DISE sleep with propofol, and present in all OSAS patients (100%). AHI and mean SaO2 showed no statistical difference between the two tests, with and without propofol. However, minimum SaO2 was significantly lower during propofol infusion (88.64 for without vs. 85.04 for with propofol; P < 0.01). Regarding sleep macroarchitecture, the tests with propofol significantly increased N3 sleep and totally extinguished REM sleep (P < 0.005)., Conclusions: The results demonstrate that propofol significantly changes sleep macroarchitecture. However, the main respiratory parameters, AHI and mean SaO2 , remained unaffected. Thus, in order to determine the sites of obstruction, propofol DISE used with target-controlled infusion proved to be an effective drug for endoscopic evaluation of patients with OSAS., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Unlabelled: Only a few studies have compared the outcomes of patients kept awake during endoscopic examination and subjects submitted to drug-induced sleep endoscopy., Objective: This study aimed to compare the endoscopic findings of patients submitted to outpatient endoscopy and endoscopic examination with sedation by propofol based on the Fujita Classification., Method: This cross-sectional cohort study enrolled 34 patients. The subjects underwent ENT examination, nasal endoscopy with Müller's maneuver, and drug-induced sleep endoscopy with propofol. The Fujita Classification was used to compare the two modes of endoscopic examination. The examinations were correlated to patient clinical data such as BMI, age, and OSAS severity., Results: There was no agreement between the two modes of endoscopic examination, whether for the group in general or for the analyzed subgroups., Conclusion: There was no agreement between the endoscopic findings of endoscopic examinations done with the patient awake or in drug-induced sleep.

Objective: Obstructive sleep apnea is frequent during the acute phase of stroke, and it is associated with poorer outcomes. A well-established relationship between supine sleep and obstructive sleep apnea severity exists in non-stroke patients. This study investigated the frequency of supine sleep and positional obstructive sleep apnea in patients with ischemic or hemorrhagic stroke., Methods: Patients who suffered their first acute stroke, either ischemic or hemorrhagic, were subjected to a full polysomnography, including the continuous monitoring of sleep positions, during the first night after symptom onset. Obstructive sleep apnea severity was measured using the apnea-hypopnea index, and the NIHSS measured stroke severity., Results: We prospectively studied 66 stroke patients. The mean age was 57.6 ± 11.5 years, and the mean body mass index was 26.5 ± 4.9. Obstructive sleep apnea (apnea-hypopnea index ≥5) was present in 78.8% of patients, and the mean apnea-hypopnea index was 29.7 ± 26.6. The majority of subjects (66.7%) spent the entire sleep time in a supine position, and positional obstructive sleep apnea was clearly present in the other 23.1% of cases. A positive correlation was observed between the NIHSS and sleep time in the supine position (r(s) = 0.5; p<0.001)., Conclusions: Prolonged supine positioning during sleep was highly frequent after stroke, and it was related to stroke severity. Positional sleep apnea was observed in one quarter of stroke patients, which was likely underestimated during the acute phase of stroke. The adequate positioning of patients during sleep during the acute phase of stroke may decrease obstructive respiratory events, regardless of the stroke subtype.