A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: A proposal for indications.

OBJECTIVE: To evaluate whether and when Drug-Induced Sleep Endoscopy (DISE) changes diagnosis and treatment plan in pediatric Obstructive Sleep Apnoea Syndrome (OSAS) with the aim to identify specific subgroups of patients for whom DISE should be especially considered. METHODS: A case-control study of DISE in 150 children with OSAS. Pre-operative OSA were assessed through detailed history, Chervin questionnaire, physical examination and overnight polysomnography. The group of study was divided into three subgroups according to clinical and polysomnographyc criteria: conventional OSAS, disproportional OSAS and persistent OSAS. Endoscopic evaluation of the upper airway during DISE was scored using Chan classification. Surgical treatment was tailored individually upon the basis of sleep endoscopy findings: performance of any surgery other than tonsillectomy and adenoidectomy (T&A) was considered as a change of the treatment plan. Cases and controls were compared considering presence and absence of DISE-directed extra surgery, respectively. RESULTS: 150 patients with mean age (SD) 56.09 (23.94) months and mean apnoea-hypopnea index (AHI) of 5.79 (6.52) underwent DISE. The conventional subgroup represented the 58.67% of the sample (n = 88), while the disproportional one counted for the 26.67% (n = 40), and the persistent one for 14.66% (n = 22) of the population. Sleep endoscopy changed the surgical plan in 4.5% of conventional OSAS, 17.5% of disproportional OSAS and 72.7% of persistent OSAS (p < 0.005). Overall, a change of the treatment plan operated by DISE was associated with a non-conventional OSAS status (OR = 6; 95% CI = 1.6-26.4). CONCLUSIONS: DISE is a safe procedure in children suffering from OSAS, and, despite being unnecessary in conventional cases of OSA, DISE should be considered not only in syndromic children, as previously demonstrated, but also in the general non-syndromic pediatric population, in the case of non-conventional OSA patients, and in children with persistent OSAS.

Exploración videosomnoscópica bajo sueño inducido en los trastornos respiratorios del sueño en niños / Drug-induced sleep-endoscopy in children's sleep related breathing disorders

Introducción y objetivos: La somnoscopia es una herramienta válida para evaluar los lugares de obstrucción de la vía aérea superior responsables del síndrome de apnea-hipoapnea del sueño infantil. El objetivo es mostrar la experiencia de un servicio de ORL con somnoscopia en niños candidatos a cirugía de síndrome de apnea del sueño. Métodos: Incluye 56 casos entre 2 y 12 años de edad que acuden a la consulta de otorrinolaringología con clínica de ronquido y apnea. Se practica polisomnografía previa y el IAH medio fue 6,32±8,71. La distribución de casos fue: 10 residuales (17,85%), 15 desproporción clínica (26,78%) y 31 convencionales (55,35%). Todas las exploraciones se llevan a cabo en quirófano y se utiliza la clasificación de Chan para valorar las zonas de colapso. Resultados: En los casos de enfermedad residual las regiones más afectadas son las paredes laterales de la orofaringe (70%) y los cornetes (70%), y la cirugía aplicada con más frecuencia la amigdalectomía total seguida de la reducción de la base de la lengua y la radiofrecuencia de los cornetes. En los casos de desproporción clínica se halló mayor frecuencia de colapso en las paredes laterales de la orofaringe (93,3%) y adenoides (66,6%). La cirugía más frecuente en este grupo fue la adenoidectomía con amigdalotomía por radiofrecuencia. Conclusión: La somnoscopia es una técnica de exploración que puede ser incorporada con facilidad a la práctica habitual, especialmente en niños con síndrome de apnea del sueño residual o en aquellos en los que se sospeche alguna otra causa aparte de la hipertrofia adenoamigdalar (AU)

Introduction: Drug-induced sedation endoscopy is a valid tool to assess site obstruction of the upper airway responsible for children's obstructive Sleep Apnea. The aim is to show the experience of an ENT department with Drug-induced sedation endoscopy in children selected for sleep apnea surgery. Methods: Includes 56 cases between 2 and 12 years old (mean age: 59,13±27,29 months) presenting at the Otorhinolaryngology consultation clinic with snoring and apnea. Prior polysomnography had been practiced and mean AHI was 6,32±8,71. The distribution of cases was 10 persistent sleep apnea (17.85%), 15 clinical disproportion (26.78%) and 31 conventional (55.35%). All sleep endoscopies were performed in the operating room and Chan classification was used to assess the areas of collapse. Results: In cases of residual disease the most affected regions were the side walls of the oropharynx (70%) and turbinate (70%) and the most frequently applied surgery was total tonsillectomy followed by second tongue tonsil reduction and turbinate radiofrequency. In clinical cases of desproportion, the most affected regions were the oropharyngeal side walls (93.3%) and adenoids (66.6%). The most frequently applied surgery in this group was adenoidectomy and radiofrequency tonsillotomy. Conclusion: drug-induced sedation endoscopy is a technique that can be incorporated easily into medical practice, mostly in children with residual sleep apnea syndrome or those suspected to have some cause other than adenotonsillar hypertrophy (AU)

Drug-induced sleep-endoscopy in children's sleep related breathing disorders. / Exploración videosomnoscópica bajo sueño inducido en los trastornos respiratorios del sueño en niños.

INTRODUCTION: Drug-induced sedation endoscopy is a valid tool to assess site obstruction of the upper airway responsible for children's obstructive Sleep Apnea The aim is to show the experience of an ENT department with Drug-induced sedation endoscopy in children selected for sleep apnea surgery METHODS: Includes 56 cases between 2 and 12 years old (mean age: 59,13±27,29 months) presenting at the Otorhinolaryngology consultation clinic with snoring and apnea. Prior polysomnography had been practiced and mean AHI was 6,32±8,71. The distribution of cases was 10 persistent sleep apnea (17.85%), 15 clinical disproportion (26.78%) and 31 conventional (55.35%). All sleep endoscopies were performed in the operating room and Chan classification was used to assess the areas of collapse. RESULTS: In cases of residual disease the most affected regions were the side walls of the oropharynx (70%) and turbinate (70%) and the most frequently applied surgery was total tonsillectomy followed by second tongue tonsil reduction and turbinate radiofrequency. In clinical cases of desproportion, the most affected regions were the oropharyngeal side walls (93.3%) and adenoids (66.6%). The most frequently applied surgery in this group was adenoidectomy and radiofrequency tonsillotomy. CONCLUSION: Drug-induced sedation endoscopy is a technique that can be incorporated easily into medical practice, mostly in children with residual sleep apnea syndrome or those suspected to have some cause other than adenotonsillar hypertrophy.