Drug-induced sleep endoscopy (DISE), is three dimensional, real time assessment of the upper airway obstruction , which occurs in patients with obstructive sleep apnoea during sleep. Sleep is induced pharmacologically, to mimic natural sleep and snoring. A naso-endoscope is inserted to visualize the exact site of obstruction which could be velum, oropharynx, including tonsils, tongue base, and epiglottis. It is important to identify the sites of obstruction in order to individualize the surgical treatment of OSA .So surgery is site specific, avoids extensive resection and also improves outcome. To reproduce snoring and apnea patterns similar to natural sleep and at the same time cause abolition of reflexes to allow for endoscopy, we compared conventional sedating technique using Propofol and Dexmedetomidine

We conducted a hospital based prospective, randomized controlled comparative study over 2 years, of 20 patients with OSA proven by polysomnography. Patients were divided into 2 groups of 10 each. All patients were pre medicated with Inj. Glycopyrrolate and Inj Midazolam 20 minutes before the procedure, and upper airway was anesthetized using Lignocaine viscous mouth wash and lignocaine soaked nasal pledgets. Sleep was induced with either propofol or dexmedetomidine and Modified Ramsay Sedation scale was used to assess the level of sedation. Depth of anesthesia was monitored using BIS and care was taken to not anesthetize the patient to a BIS < 60 .At a MRSS of 4 /5 endoscopy was performed and specific sites of obstruction were visualized.

Both, Propofol and Dexmedetomidine used for DISE, were able to induce adequate sleep level to perform endoscopy and at the same time not requiring intubation. Propofol had the added advantage of loss of upper airway reflexes hence lesser amount of the drug and top ups were required than dexmedetomidine, with fewer side effects .

Propofol is more conducive than dexmedetomidine in drug induced sleep endoscopy