Effects of dexmedetomidine and propofol on the key endotypes of OSA: A randomized, single-blind, placebo-controlled, crossover trial

IF 3.8 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine Pub Date : 2025-02-26 DOI:10.1016/j.sleep.2025.02.041

Chunbo Li , Haiting Fan , Yujuan Duan , Dan Wang , Yang Lin , Wenjun Xin , Renqiang Ma , Weiping Wen , Yan Wu

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Abstract

Background

Drug-induced sleep has been shown to facilitate the diagnosis of obstructive sleep apnea (OSA). However, the effects of commonly used sedatives, such as dexmedetomidine and propofol, on the endotypic traits of OSA remained unclear.

Objective

We aim to investigate the impact of dexmedetomidine and propofol on OSA endotypic traits.

Methods

We conducted a randomized, single-blind, placebo-controlled, crossover trial in adult patients with OSA, comparing the OSA endotypic traits and polysomnography parameters among the interventions of placebo, dexmedetomidine and propofol.

Results

16 patients completed the trial and were enrolled for analysis. Both dexmedetomidine and propofol worsened pharyngeal collapsibility as indicated by a lower Vpassive (mean difference: 6.1 [95 % CI -9.1 to −3.0]%_eupnea for dexmedetomidine versus placebo, p = 0.040; −16.5 [95 % CI -24.1 to −9.0]%_eupnea for propofol versus placebo, p < 0.001), with propofol causing a greater effect (−10.4 [95 % CI -17.8 to −3.2]%_eupnea for propofol versus dexmedetomidine, p < 0.001). Dexmedetomidine maintained upper airway gain, while propofol diminished it compared to placebo (p = 0.001). Both dexmedetomidine and propofol increased arousal threshold (p = 0.006 and p < 0.001, respectively). Dexmedetomidine had no effect on loop gain, whereas propofol elevated it (p = 0.004). Compared to placebo, dexmedetomidine had no impact on apnea-hypopnea index (AHI) or saturation of peripheral oxygen (SpO₂). During propofol sedation, AHI in stages N1 (p < 0.001), N2 (p < 0.001) and the entire NREM (p = 0.038) sleep showed increases, and nadir SpO₂ for NREM stage exhibited a decrease (p = 0.006).

Conclusions

Dexmedetomidine had less impact on OSA endotypic traits compared to propofol, and had no negative effects on AHI and SpO₂.

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来源期刊

Sleep medicine 医学-临床神经学

CiteScore

8.40

自引率

6.20%

发文量

1060

审稿时长

49 days

期刊介绍： Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without. A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry. The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.