Drug-induced sedation endoscopy in pediatric obstructive sleep apnea syndrome

• Upper airway obstruction was evaluated in surgically naive obstructive sleep apnea (OSAS) children.
• Drug-induced sedation endoscopy (DISE) was used to identify adenotonsillar obstruction.
• Obstruction was found in the majority of OSAS children without comorbidity or craniofacial anomalies.
• More than half of the patients studied had multi-level obstruction.
• We recommend a scoring protocol of pediatric DISE including fixed upper airway abnormalities and dynamic obstructions.
• DISE findings were helpful to select patients for upper airway surgery or non-surgical treatment.

AimTo describe the pattern of upper airway (UA) obstruction during drug-induced sedation endoscopy (DISE) and to evaluate the outcome of DISE-directed treatment.MethodsProspective study of DISE in surgically naive obstructive sleep apnea syndrome (OSAS) children without syndromic comorbidity or craniofacial abnormalities. Treatment was individually tailored according to UA findings during DISE and polysomnographic data. Reported values are median (lower–upper quartile).ResultsThirty-seven children aged 4.1 years (2.1–6.0), with body mass index z-score 0.3 (−0.9 to 0.9), and obstructive apnea–hypopnea index (oAHI) 9.0/h (6.1–19.3) were included. Adenotonsillar obstruction was found in 33 cases (89%) as an isolated entity or as part of a multi-level obstruction. These children were treated with adenotonsillectomy (n = 28), adenoidectomy (n = 3), or tonsillectomy (n = 2). The remaining four patients received non-surgical treatment. Pre-postoperative polysomnographic data in 22 patients showed a significant improvement in oAHI from 8.6/h (6.7–20.7) to 1.0/h (0.6–2.0) (P = 0.001). Only two of these 22 children had residual OSAS (oAHI ≥ 5/h), indicating a success rate of 91%.ConclusionsBased on UA findings during DISE, a non-surgical treatment was proposed for 11% of children. A 91% success rate was obtained in those treated with (adeno)tonsillectomy. These data suggest that DISE may be helpful to identify patients most likely to benefit from UA surgery.