Polysomnography outcomes of sleep endoscopy–directed intervention in surgically naïve children at risk for persistent obstructive sleep apnea
Drug-induced sleep endoscopy (DISE) is useful in children with obstructive sleep apnea (OSA) that persists after adenotonsillectomy (AT), but its utility in surgically naïve children is unclear. We report polysomnography outcomes of surgically naïve children who underwent DISE-directed intervention because they were considered high risk for persistent OSA after adenotonsillectomy.
This study is a case series of 62 surgically naïve children with OSA who were considered high risk for persistence after AT and underwent DISE-directed intervention with pre- and postoperative polysomnography between 2012 and 2016. Analysis was performed with the paired t test.
Children were on average 5.9 (± 5.5, 0.2–18.6) years old at the time of surgery, 68% male, 18% obese, and 60% white. Thirty-eight percent had a syndromic diagnosis: 19% trisomy 21, 11% hypotonic neuromuscular disorder, and 8% craniofacial condition. The remaining 62% were non-syndromic but underwent DISE because they had at least one risk factor for OSA persistence after AT (age > 7 years, black race, 1+ tonsils, obesity, and/or severe OSA). Forty-two percent underwent AT, while 58% underwent treatment other than AT, including 18% who had multilevel surgery. Children improved significantly in 4 out of 5 polysomnography parameters tested, including obstructive apnea-hypopnea index (oAHI; 22.2 to 7.2, p < 0.01) and oxygen nadir (82 to 87, p < 0.01). Thirty-eight (61%) had a postoperative oAHI < 5; 16 (21%) had a postoperative oAHI < 2.
DISE resulted in intervention other than AT in 58% of surgically naïve children at high risk for persistent OSA after AT. DISE-directed intervention resulted in significant mean improvement in postoperative OSA.
KeywordsSleep endoscopy DISE Pediatric Sleep apnea
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 6.Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, Mitchell RB, Amin R, Katz ES, Arens R, Paruthi S, Muzumdar H, Gozal D, Thomas NH, Ware J, Beebe D, Snyder K, Elden L, Sprecher RC, Willging P, Jones D, Bent JP, Hoban T, Chervin RD, Ellenberg SS, Redline S, Childhood Adenotonsillectomy T (2013) A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 368(25):2366–2376. https://doi.org/10.1056/NEJMoa1215881 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, Kaditis AG, Splaingard D, Splaingard M, Brooks LJ, Marcus CL, Sin S, Arens R, Verhulst SL, Gozal D (2010) Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 182(5):676–683. https://doi.org/10.1164/rccm.200912-1930OC CrossRefPubMedGoogle Scholar
- 18.Shete MM, Stocks RM, Sebelik ME, Schoumacher RA (2010) Effects of adeno-tonsillectomy on polysomnography patterns in Down syndrome children with obstructive sleep apnea: a comparative study with children without Down syndrome. Int J Pediatr Otorhinolaryngol 74(3):241–244. https://doi.org/10.1016/j.ijporl.2009.11.006 CrossRefPubMedGoogle Scholar
- 24.Fishman G, Zemel M, DeRowe A, Sadot E, Sivan Y, Koltai PJ (2013) Fiber-optic sleep endoscopy in children with persistent obstructive sleep apnea: inter-observer correlation and comparison with awake endoscopy. Int J Pediatr Otorhinolaryngol 77(5):752–755. https://doi.org/10.1016/j.ijporl.2013.02.002 CrossRefPubMedGoogle Scholar
- 26.Gazzaz MJ, Isaac A, Anderson S, Alsufyani N, Alrajhi Y, El-Hakim H (2017) Does drug-induced sleep endoscopy change the surgical decision in surgically naive non-syndromic children with snoring/sleep disordered breathing from the standard adenotonsillectomy? A retrospective cohort study. J Otolaryngol Head Neck Surg 46(1):12. https://doi.org/10.1186/s40463-017-0190-6 CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Boudewyns A, Saldien V, Van de Heyning P, Verhulst S (2018) Drug-induced sedation endoscopy in surgically naive infants and children with obstructive sleep apnea: impact on treatment decision and outcome. Sleep Breath 22(2):503–510. https://doi.org/10.1007/s11325-017-1581-7 CrossRefPubMedGoogle Scholar
- 29.Boudewyns A, Van de Heyning P, Verhulst S (2017) Drug-induced sedation endoscopy in children < 2 years with obstructive sleep apnea syndrome: upper airway findings and treatment outcomes. Eur Arch Otorhinolaryngol 274(5):2319–2325. https://doi.org/10.1007/s00405-017-4481-3 CrossRefPubMedGoogle Scholar
- 32.Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep M (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619. https://doi.org/10.5664/jcsm.2172 CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Sheldon SH, Ferber R, Kryger MH (2014) Principles and practice of pediatric sleep medicine. Second edition. Elsevier Saunders, LondonGoogle Scholar
- 39.Farhood Z, Ong AA, Nguyen SA, Gillespie MB, Discolo CM, White DR (2016) Objective outcomes of supraglottoplasty for children with laryngomalacia and obstructive sleep apnea: a meta-analysis. JAMA Otolaryngol Head Neck Surg 142(7):665–671. https://doi.org/10.1001/jamaoto.2016.0830 CrossRefPubMedGoogle Scholar