Prevalence of Sentinel Central Events During Drug-Induced Sleep Endoscopy

Introduction: With the recent addition of airflow and respiratory effort channels, our group has observed central and mixed apnea events during the early portions of drug-induced sleep endoscopy (DISE). We measured the frequency and timing of sentinel central and/or mixed events (SCent), as well as assessed for differences in VOTE classification compared to obstructive events.

Methods: A prospective cohort of patients at a tertiary academic medical center underwent DISE between June 2020 and November 2022. Nasal airflow, thoraco-abdominal effort belt signals and videoendoscopy were simultaneously captured in a polysomnography recording platform, allowing for scoring of respiratory events. Demographic, sleep study, and DISE data were analyzed using descriptive and Student’s t-test statistics.

Results: The cohort (n=104) was, on average, middle-aged (mean [± SD] of 53.6±12.1 years), male (68.3%), overweight (BMI 29.7±5.3 kg/m2), and with severe OSA (30.9±18.7 events/hour). Forty-seven patients (45%) were found to have at least one SCent. There were no statistically significant differences in demographics or AHI between those with and without SCent. Among those with SCent, the average transition to obstructive pathology occurred after 7.29±2.70 minutes, with at least 95% of patients expected to transition to obstructive pathology before 11.87 minutes based on the one-sided prediction interval. Eleven out of 47 patients (23.4% [95% CI: 12.3%-38.0%]) with SCent had significant variability between the central/mixed and obstructive VOTE scores.

Conclusions: Central pathology is remarkably common during the onset of propofol, with at least 95% of patients expected to transition to obstructive events occurring by ~12 minutes. In addition, roughly 1 in 4 patients demonstrate markedly different VOTE scores between central and obstructive events. These factors should raise awareness of central events during DISE and consideration of delaying airway evaluation for several minutes in the absence of respiratory airflow and effort monitoring.