Upper Airway Collapsibility Evaluation in Different Sedative Levels by Sleep Endoscopy

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01100554
Recruitment Status : Unknown
Verified April 2010 by Chang Gung Memorial Hospital.
Recruitment status was:  Recruiting
First Posted : April 9, 2010
Last Update Posted : April 13, 2010
Information provided by:
Chang Gung Memorial Hospital

Brief Summary:
The purpose of this study is to evaluate the upper airway collapsibility by sleep endoscopy in different sedative levels. Propofol pump infusion will be used to achieve conscious sedation. Bispectral Index monitor will be applied to the monitor the conscious level. Two different sedative levels (BIS 65-75, 50-60) will be achieved for upper airway evaluation. The severities of upper airway obstruction will be evaluated the correlation to the disease severities. Mandible advancement will be done to evaluate the response for oral appliance.

Condition or disease Intervention/treatment Phase
Bronchoscopy Obstructive Sleep Apnea Conscious Sedation Device: Sleep endoscopy Not Applicable

Detailed Description:

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a disorder characterized by recurrent upper airway collapse during sleep. Clinical consequences as increased cardiovascular events and automobile accidents were noted. Polysomnography is diagnostic while continuous positive airway pressure (CPAP) is the standard treatment. The adherence of CPAP treatment remained suboptimal, between 29 to 83%. In selected cases, alternative treatments were considered useful. However, how to choose candidates is still an issue.

Sleep endoscopy has been introduced since 1991 to allow direct visualization of the upper airway under sleep simulation. It predicts better outcome in non-adherent OSAHS patients who received alternative treatment. However, the ideal dose, drug, and sedative depth were not known.

Bispectral Index (BIS) monitor is a noninvasive neurophysiological monitoring device that been introduced since late 1990's. By applying a sensor to the forehead, the BIS obtained electroencephalograms(EEG) and electromyograms(EMG) which were transformed into simplified scaled numbers through 0-100. It has been applied in the real time monitor of anesthesia depth during operation or recovery, monitor of sleep in critical illness patients and gastrointestinal endoscopy sedation.

This study focuses on CPAP non-adherent patients. It evaluates the upper airway collapsibility in awake and two different sedative levels, BIS 65-75 (light sedation) and BIS 50-60(deep sedation). Conscious sedation will be achieved by propofol pump infusion. No benzodiazepam or opioid are used to avoid the effect of upper airway muscle tone and respiratory drive. The patency over the velopharynx, oropharynx, larynx, and hypopharynx will be recorded. Specific obstruction patterns such as tongue base retraction, epiglottis anterior-posterior decent, omega-shaped epiglottis,and bilateral arytenoids anterior drawing will also be recorded. The correlation of the upper airway collapsibility between sedative depth and sleep stages (ex. NREM vs. REM) will be evaluated. Besides, mandible advancement will be done under deep sedation. The response will guide further treatment choice for those CPAP non-adherent patient.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 120 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Upper Airway Collapsibility Evaluation in Different Sedative Levels by Sleep Endoscopy
Study Start Date : October 2009
Estimated Primary Completion Date : June 2010

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Endoscopy
U.S. FDA Resources

Arm Intervention/treatment
Experimental: all patients Device: Sleep endoscopy
Conscious sedation will be done under intravenous propofol infusion. The sedative level would be monitored and adjusted accord to the Bispectral Index monitor. After the adequate sedative level is achieved, a bronchoscopy (Olympus, BF) was inserted from the right nostril. The velopharynx, oropharynx, larynx, and hypopharynx obstructions were evaluated.
Other Names:
  • Bispectral Index
  • electroencephalograms(EEG)
  • electromyograms(EMG)

Primary Outcome Measures :
  1. Upper airway collapsibility
    The severity of upper aiwray collapses in different sedative levels will be evaluated by the sleep endoscopy. The correlation between the disease severities and airway collapsibilities will be evaluated.

Secondary Outcome Measures :
  1. Mandible advancement response and oral appliance response [ Time Frame: 6 month and 1 year after oral appliance ]
    Patients with response to mandible advancement will be referred to oral appliance to treat OSA. The treatment outcome will be followed.

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Normal volunteer: cases with no sleep apnea symptoms and AHI<5
  • Study cases: CPAP non-adherent sleep apnea patient

Exclusion Criteria:

  • ASA > 3
  • allergy to propofol, xylocaine, or food (egg, bean, milk)
  • congestive heart failure
  • severe obstructive airway disease
  • head injury, seizure, cerebrovascular accident history
  • age < 18 year-old

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01100554

Contact: Yung-Lun Ni, MD 886-3-3281200 ext 5108

Department or Thoracic Medicine, Chang Gung Memorial Hospital Recruiting
Taipei, Taiwan
Contact: Yung-Lun Ni, MD   
Sponsors and Collaborators
Chang Gung Memorial Hospital
Study Director: Yu-Lun Lo, MD Chang Gung Memorial Hospital

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Yung-Lun Ni, Chang Gung Memorial Hospital Identifier: NCT01100554     History of Changes
Other Study ID Numbers: 980717A3
First Posted: April 9, 2010    Key Record Dates
Last Update Posted: April 13, 2010
Last Verified: April 2010

Additional relevant MeSH terms:
Sleep Apnea, Obstructive
Sleep Apnea Syndromes
Respiration Disorders
Respiratory Tract Diseases
Sleep Disorders, Intrinsic
Sleep Wake Disorders
Nervous System Diseases
Hypnotics and Sedatives
Central Nervous System Depressants
Physiological Effects of Drugs