Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2018; 10(11): 340-347
Published online Nov 16, 2018. doi: 10.4253/wjge.v10.i11.340
Polysomnographic assessment of respiratory disturbance during deep propofol sedation for endoscopic submucosal dissection of gastric tumors
Ryuma Urahama, Masaya Uesato, Mizuho Aikawa, Yukiko Yamaguchi, Koichi Hayano, Tomoaki Matsumura, Makoto Arai, Reiko Kunii, Shiroh Isono, Hisahiro Matsubara
Ryuma Urahama, Masaya Uesato, Mizuho Aikawa, Yukiko Yamaguchi, Koichi Hayano, Hisahiro Matsubara, Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
Tomoaki Matsumura, Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
Makoto Arai, Department of Medical Oncology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
Reiko Kunii, Staff of Clinical Laboratory, Chiba University Hospital, Chiba 260-8677, Japan
Shiroh Isono, Department of Anesthesiology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
Author contributions: Uesato M contributed to study conception; Urahama R and Uesato M contributed to study design and writing of article; Urahama R, Uesato M, Aikawa M, Yamaguchi Y, Hayano K, Matsumura T, Arai M contributed to diagnosis and treatment; Urahama R and Kunii R contributed to data acquisition; Urahama R, Uesato M and Isono S contributed to data analysis and interpretation; all authors discussed the results on article and contributed to final approval.
Supported by a grant received from Japan Society for the Promotion of Science, NO. 15K09056.
Institutional review board statement: This study was approved by the institutional Ethics Committee (#1902-2014, Graduate School of Medicine, Chiba University, Chiba, Japan).
Informed consent statement: The patients involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Data sharing statement: No additional data are available.
STROBE statement: The guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masaya Uesato, MD, PhD, Assistant Professor, Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan. uesato@faculty.chiba-u.jp
Telephone: +81-43-226-2110 Fax: +81-43-226-2113
Received: July 5, 2018
Peer-review started: July 5, 2018
First decision: July 19, 2018
Revised: August 21, 2018
Accepted: October 8, 2018
Article in press: October 9, 2018
Published online: November 16, 2018
Processing time: 134 Days and 14.9 Hours
ARTICLE HIGHLIGHTS
Research background

Endoscopic treatments often take long time, however procedures are better tolerated in terms of patient satisfaction and safety when sedation is administered.

Research motivation

Recent guidelines on gastrointestinal endoscopy strongly recommend pulse oximetry and careful monitoring of breathing during sedation. But it is unclear as to how many non-critical respiratory disturbances occurred in addition to critical events.

Research objectives

The objectives are to reveal that polysomnography (PSG) can accurately evaluate respiratory disturbance incidence during sedation for gastric endoscopic submucosal dissection (ESD) compare to pulse oximetry alone and to characterize breathing patterns.

Research methods

This study included 10 elderly patients with early gastric cancer undergoing ESD under propofol sedation. PSG measurements were acquired. The comparison of respiratory disturbances between PSG and pulse oximetry was tested by the apnea hypopnea index (AHI), defined as the number of apnea and hypopnea instances per hour during sedation, with and without hypoxemia. The breathing pattern was characterized by the waveform of PSG.

Research results

PSG detected 207 respiratory disturbances in the 10 patients. PSG yielded a significantly greater AHI (10.44 ± 5.68/h) compared with pulse oximetry (1.54 ± 1.81/h, P < 0.001). Obstructive AHI (9.26 ± 5.44/h) was significantly greater than central AHI (1.19 ± 0.90/h, P < 0.001). Compared with pulse oximetry, PSG detected the 25 instances of respiratory disturbances with hypoxemia 107.4 s earlier on average.

Research conclusions

PSG can better detect respiratory irregularities in detail compared with pulse oximetry and thus provide superior AHI values, leading to distinguish between obstructive and central events clearly.

Research perspectives

It is not necessary to take all kinds of PSG monitoring for the patients under sedation. Among PSG monitoring, nasal pressure measurement is potentially useful for respiratory monitoring and that it must be tested in future clinical studies. Moreover, we will clarify what characters of patients require strict monitoring before endoscopic procedures under sedation.