{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T01:36:53Z","timestamp":1777081013153,"version":"3.51.4"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Dexmedetomidine is one of the anesthetics of choice for drug induced sleep endoscopy (DISE), with advantages including limited respiratory depression, analgesia, and decreased incidence of emergence delirium. However, challenges with determining sedation levels and prolonged recovery have limited its usage. An improved understanding of the effect of dexmedetomidine on the level of sedation and the corresponding electroencephalographic (EEG) changes could help overcome these barriers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty-one patients received dexmedetomidine sedation with Richmond Agitation-Sedation Scale (RASS) score assessment and continuous EEG monitoring via SedLine for DISE. We constructed a pharmacokinetic model to determine continuous dexmedetomidine blood concentration. From the SedLine, we extracted the patient state index (PSI), and from the EEG we calculated the spectral edge frequency 95% (SEF95) and the correlation dimension (CD), a type of fractal dimension used to assess the complexity of a system. These metrics were subsequently compared against one another and with the dexmedetomidine concentration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our pharmacokinetic model yielded a two-compartment model with volumes of 51.8\u2009L and 106.2\u2009L, with clearances of 69.5 and 168.9\u2009L\/h, respectively, and a time to effect of 9\u2009min, similar to prior studies. Based on this model, decreasing RASS score, SEF95, CD, and PSI were all significantly associated with increasing dexmedetomidine concentration (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001, <jats:italic>p<\/jats:italic>\u2009=\u20090.006, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001 respectively). The CD, SEF95, and PSI better captured the effects of increasing dexmedetomidine concentration as compared to the RASS score. Simulating dexmedetomidine concentration based on titration to target levels derived from CD and PSI confirmed commonly used dexmedetomidine infusion dosages.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Dexmedetomidine use for DISE confirmed previous pharmacokinetic models seen with dexmedetomidine. Complex EEG metrics such as PSI and CD, as compared to RASS score and SEF95, better captured changes in brain state from dexmedetomidine and have potential to improve the monitoring of dexmedetomidine sedation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnins.2023.1144141","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T21:41:31Z","timestamp":1689370891000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["EEG response of dexmedetomidine during drug induced sleep endoscopy"],"prefix":"10.3389","volume":"17","author":[{"given":"Lichy","family":"Han","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David R.","family":"Drover","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne C.","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit R.","family":"Saxena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah L.","family":"Eagleman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladimir","family":"Nekhendzy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica","family":"Pritchard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robson","family":"Capasso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.clinph.2017.10.005","article-title":"Dexmedetomidine promotes biomimetic non-rapid eye movement stage 3 sleep in humans: a pilot study","volume":"129","author":"Akeju","year":"2018","journal-title":"Clin. Neurophysiol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1097\/ALN.0000000000000419","article-title":"A comparison of propofol- and dexmedetomidine-induced electroencephalogram dynamics using spectral and coherence analysis","volume":"121","author":"Akeju","year":"2014","journal-title":"Anesthesiology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1177\/0194599815625972","article-title":"Variable findings for drug-induced sleep endoscopy in obstructive sleep apnea with propofol versus dexmedetomidine","volume":"154","author":"Capasso","year":"2016","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1007\/s00228-015-1948-2","article-title":"Dexmedetomidine pharmacokinetics in the obese","volume":"71","author":"Cort\u00ednez","year":"2015","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1002\/(SICI)1520-6017(200004)89:4<519::AID-JPS9>3.0.CO;2-U","article-title":"Influence of cardiac output on dexmedetomidine pharmacokinetics","volume":"89","author":"Dutta","year":"2000","journal-title":"J. Pharm. Sci."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e0223921","DOI":"10.1371\/journal.pone.0223921","article-title":"Nonlinear dynamics captures brain states at different levels of consciousness in patients anesthetized with propofol","volume":"14","author":"Eagleman","year":"2019","journal-title":"PLoS One"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1097\/00000542-200008000-00016","article-title":"The effects of increasing plasma concentrations of dexmedetomidine in humans","volume":"93","author":"Ebert","year":"2000","journal-title":"Anesthesiology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0167-2789(83)90298-1","article-title":"Measuring the strangeness of strange attractors","volume":"9","author":"Grassberger","year":"1983","journal-title":"Physica. D"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2014\/805013","article-title":"Interpatient variability in dexmedetomidine response: a survey of the literature","volume":"2014","author":"Holliday","year":"2014","journal-title":"Sci. World J."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.1399-6576.2007.01537.x","article-title":"Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep","volume":"52","author":"Huupponen","year":"2008","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1093\/bja\/aer441","article-title":"Population pharmacokinetics of dexmedetomidine during long-term sedation in intensive care patients","volume":"108","author":"Iirola","year":"2012","journal-title":"Br. J. Anaesth."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1093\/bja\/aer196","article-title":"Wide inter-individual variability of bispectral index and spectral entropy at loss of consciousness during increasing concentrations of dexmedetomidine, propofol, and sevoflurane","volume":"107","author":"Kaskinoro","year":"2011","journal-title":"Br. J. Anaesth."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/jcpt.13085","article-title":"Target-controlled infusion of dexmedetomidine effect-site concentration for sedation in patients undergoing spinal anaesthesia","volume":"45","author":"Kim","year":"2020","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"GE01\u2013GE04","DOI":"10.7860\/JCDR\/2014\/9624.4946","article-title":"Dexmedetomidine in current anaesthesia practice- a review","volume":"8","author":"Naaz","year":"2014","journal-title":"J. Clin. Diagn. Res."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1475-925X-3-7","article-title":"Nonlinear analysis of EEG signals at different mental states","volume":"3","author":"Natarajan","year":"2004","journal-title":"Biomed. Eng. Online"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1097\/00000542-200302000-00024","article-title":"The \u03b12-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects","volume":"98","author":"Nelson","year":"2003","journal-title":"Anesthesiology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.7150\/ijms.54677","article-title":"Changes in electroencephalographic power and bicoherence spectra according to depth of dexmedetomidine sedation in patients undergoing spinal anesthesia","volume":"18","author":"Seo","year":"2021","journal-title":"Int. J. Med. Sci."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1164\/rccm.2107138","article-title":"The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients","volume":"166","author":"Sessler","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2266","DOI":"10.1016\/j.clinph.2005.06.011","article-title":"Nonlinear dynamical analysis of EEG and MEG: review of an emerging field","volume":"116","author":"Stam","year":"2005","journal-title":"Clin. Neurophysiol."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1097\/00000539-199711000-00033","article-title":"Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine","volume":"85","author":"Talke","year":"1997","journal-title":"Anesth. Analg."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1093\/bja\/88.5.669","article-title":"Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive care","volume":"88","author":"Venn","year":"2002","journal-title":"Br. J. Anaesth."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e0199120","DOI":"10.1371\/journal.pone.0199120","article-title":"Different effects of propofol and dexmedetomidine sedation on electroencephalogram patterns: wakefulness, moderate sedation, deep sedation and recovery","volume":"13","author":"Xi","year":"2018","journal-title":"PLoS One"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1016\/j.clinthera.2021.06.004","article-title":"Protein binding and population pharmacokinetics of dexmedetomidine after prolonged infusions in adult critically ill patients","volume":"43","author":"Yan","year":"2021","journal-title":"Clin. Ther."}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2023.1144141\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T21:41:33Z","timestamp":1689370893000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2023.1144141\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,14]]},"references-count":23,"alternative-id":["10.3389\/fnins.2023.1144141"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2023.1144141","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,14]]},"article-number":"1144141"}}