Background: One of the most important factors in directing treatment strategies for obstructive sleep apnea is determining the location of blockage and the pattern of upper airway alterations during sleep which can be achieved by drug induced sleep endoscopy (DISE). For DISE, midazolam, propofol, and dexmedetomidine are the usually utilized sedatives. Therefore, it's important to understand which medication combination—propofol-Dexmedetomidine or Ketamine-midazolam—better simulates natural sleep and has fewer drawbacks when used in DISE. So, we aimed to compare between the efficacy and safety of propofol- dexmedetomidine and ketamine-midazolam in OSA patients undergoing DISE.

Methods: This prospective randomized double-blind clinical study was conducted at Anesthesia, Intensive Care and Pain management Department, Faculty of Medicine, Zagazig University Hospitals on OSA adult patients undergoing DISE. All Patients were randomly divided into 2 groups of 44 patients each. Patients were randomized and allocated either in (group PD) to receive a combination of propofol and dexmedetomidine or (group KM) to receive a combination of ketamine and midazolam.

Results: the number of patients with successful completion of the procedure was 41 in group PD and 33 in KM group. Time to fall asleep was 22.65±4.67 seconds in PD group and 34.47±5.33 in KM group, with statistically significant difference between both groups (P=0.00). Regarding sedation score, it was lower in PD group than KM group (P=0.00).

Conclusion: Both Propofol-Dexmedetomidine and Ketamine-Midazolam regimens can provide adequate sedation for OSA patients undergoing DISE. However, Propofol-Dexmedetomidine combination may be preferred for DISE offering efficacy and safety.