Sedative Agents in Drug-Induced Sleep Endoscopy: Current Evidence and Future Perspectives

Resumen

Objective: To provide a comprehensive narrative review of the pharmacological agents used for sedation during DISE, comparing their pharmacological properties, effects on upper airway dynamics, safety profiles, current evidence, and clinical applications.

Methods:  A narrative review was conducted using literature retrieved from PubMed, Scopus and Google Scholar. Relevant articles, including randomized controlled trials, systematic reviews, meta-analyses, clinical guidelines, and landmark studies published in English, were reviewed. The discussion focuses on commonly used sedative agents, monitoring techniques, evidence-based recommendations, and future directions in DISE sedation.

Results: Propofol and dexmedetomidine remain the most extensively studied sedative agents for DISE. Propofol offers rapid onset, easy titration, and short recovery time but may increase upper airway collapsibility and respiratory depression. Dexmedetomidine produces sedation that more closely resembles physiological sleep while preserving respiratory function, although it has a slower onset and may cause bradycardia and hypotension. Midazolam, remifentanil, ketamine, inhalational agents, and combination regimens have also been investigated, each demonstrating unique advantages and limitations. Recent evidence supports individualized sedative selection based on patient characteristics, procedural requirements, and institutional expertise.

Conclusion: No single sedative agent fulfills all characteristics of the ideal drug for DISE. Understanding the pharmacological effects of each agent on airway physiology and sleep architecture is essential for accurate interpretation of DISE findings. Future research should focus on standardized sedation protocols, comparative multicenter studies, and precision medicine approaches to optimize diagnostic accuracy and patient safety.