Drug-induced sedation endoscopy in surgically naïve infants and children with obstructive sleep apnea: impact on treatment decision and outcome.

ABSTRACT

PURPOSE: Adenotonsillectomy (AT) is the first-line treatment for obstructive sleep apnea (OSA) in children irrespective of clinical upper airway (UA) findings. We aimed to investigate whether drug-induced sedation endoscopy (DISE) changes treatment decision and outcome in otherwise healthy children and infants with OSA. METHODS: Retrospective analysis of prospectively collected data on polysomnography, DISE, and treatment in surgically naïve, otherwise healthy infants (n = 34) and children (n = 75) with OSA. Treatment success is defined as post-treatment obstructive apnea/hypopnea index (oAHI) < 5 h-5-1, and cure is defined as oAHI < 2 h-1. RESULTS: Based upon UA findings during DISE, AT was performed in 22 infants and 57 children. oAHI improved from 16.5 h-1 (8.1-28.3) to 0.8 h-1 (0.3-4.2) (p = 0.01) in infants and from 28.6 h-1 (23.4-34.9) to 0.7 h-1 (0.4-1.8) (p < 0.001) in children. AT was successful in 84.2% of infants and 91.4% of children. A cure was obtained in 68.4% of infants and 78.7% of children. DISE changed the treatment decision in 1/3rd of infants and 1/4th of children, and they did not undergo AT. In the non-AT group, isolated adenoidectomy/tonsillectomy or non-surgical treatment was successful in 86.6% of children and in 100% of infants. Cure was achieved in 66.6% of children and 75% of infants. CONCLUSIONS: DISE performed in otherwise healthy and surgically naïve infants and children with OSA altered the therapeutic decision making in up to 1/3rd to 1/4th of the cases and resulted in comparable treatment outcomes as standard treatment by AT. The present data suggest that DISE may provide individually tailored treatment of OSA in otherwise healthy infants and children.